The Prognostic Impact of Estimated Creatinine Clearance by Bioelectrical Impedance Analysis in Heart Failure: Comparison of Different eGFR Formulas

Abstract

The estimation of glomerular filtration rate (eGFR) provides prognostic information in patients with heart failure (HF). Bioelectrical impedance analysis may calculate eGFR (Donadio formula). The aim of this study was to evaluate the impact of the Donadio formula in predicting all-cause mortality in patients with HF as compared to Cockroft-Gault, MDRD-4 (Modification of Diet in renal Disease Study), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. Four-hundred thirty-six subjects with HF (52% men; mean age 75 ± 11 years; 42% acute HF) were enrolled. Ninety-two patients (21%) died during the follow-up (median 463 days, IQR 287-669). The area under the receiver operator characteristic curve for eGFR, as estimated by Cockroft-Gault formula (AUC = 0.75), was significantly higher than those derived from Donadio (AUC = 0.72), MDRD-4 (AUC = 0.68), and CKD-EPI (AUC = 0.71) formulas. At multivariate analysis, all eGFR formulas were independent predictors of death; 1 mL/min/1.73 m² increase in eGFR-as measured by Cockroft-Gault, Donadio, MDRD-4, and CKD-EPI formulas-provided a 2.6%, 1.5%, 1.2%, and 1.6% increase, respectively, in mortality rate. Conclusions. eGFR, as calculated with the Donadio formula, was an independent predictor of mortality in patients with HF as well as the measurements derived from MDRD4 and CKD-EPI formulas, but less accurate than Cockroft-Gault.

Keywords: BIA; BNP; acute heart failure; chronic heart failure; clearance creatinine; prognosis.

Figure 1

Area under the receiver operating characteristic curves (AUC) of the different eGFR formulas in predicting all-cause mortality. AUC derived from Cockroft-Gault formula was significantly higher than those from other formulas (p < 0.05 for all). Abbreviations: AUC: area under the curve; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; MDRD-4: Modification of Diet in Renal Disease Study.

Figure 2

Kaplan-Meier survival curves relate to each formula for estimating glomerular filtration rate (GFR) at different stages of renal function: GFR: <30 mL/min/1.73 m² (red); GFR between 30 and 59 mL/min/1.73 m² (orange); GFR between 60 and 90 mL/min/1.73 m² (green); and GFR > 90 mL/min/1.73 m² (blue). Abbreviations: CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; MDRD-4: Modification of Diet in Renal Disease Study.