Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula.

Pubmed ID: 22441773

Journal: Circulation. Heart failure

Publication Date: May 1, 2012

Affiliation: Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada. Finlay.McAlister@ualberta.ca

MeSH Terms: Humans, Male, Adult, Female, Models, Biological, Aged, Aged, 80 and over, Risk Factors, Age Factors, Middle Aged, Prevalence, Chronic Disease, Heart Failure, Prospective Studies, Prognosis, Survival Rate, Stroke Volume, Kidney Diseases, Glomerular Filtration Rate, Kidney

Authors: Ahmed A, McAlister FA, Thompson SG, Rich MW, Rich MW, Brett M, Wood DA, Doughty RN, Doughty RN, Doughty RN, McMurray JJ, Poppe KK, Whalley GA, Ezekowitz J, Squire IB, Coats AJ, Andersson B, Pfeffer MA, Martínez-Sellés M, Earle N, Tribouilloy C, Swedberg K, Swedberg K, Køber L, Berry C, Squire I, Whalley G, Whalley G, Hall C, Richards AM, Troughton R, Lainchbury J, Hogg K, Norrie J, Stevenson K, McMurray J, Granger CB, Michelson EL, Olofsson B, Yusuf S, Torp-Pedersen C, Scholte op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, Cleland J, Komajda M, Komajda M, Gotsman I, Gotsman I, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Grigorian-Shamagian L, Varela-Roman A, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Gonzalez-Juanatey JR, Gonzalez-Juanatey JR, Guazzi M, Myers J, Arena R, Armstrong PW, Cujec B, Paterson I, Cowie MR, Suresh V, Poole-Wilson PA, Sutton GC, Robles JA, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Almendral J, Tarantini L, Tarantini L, Faggiano P, Senni M, Lucci D, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Macín SM, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Bayes-Genis A, Bayes-Genis A, Vazquez R, Puig T, Fernandez-Palomeque C, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, Bayes de Luna A, Newton JD, Blackledge HM, Kerzner R, Gage BF, Freedland KE, Huynh BC, Rovner A, Carney RM, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsutsui H, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Cubbon R, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, McAlister F, Held P, Bardají A, Östergren J, Lenzen J, Ezekowitz K, Freeland KE, Guide F

Cite As: McAlister FA, Ezekowitz J, Tarantini L, Squire I, Komajda M, Bayes-Genis A, Gotsman I, Whalley G, Earle N, Poppe KK, Doughty RN, Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) Investigators. Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula. Circ Heart Fail 2012 May 1;5(3):309-14. Epub 2012 Mar 22.

Studies:

Abstract

BACKGROUND: Prior studies in heart failure (HF) have used the Modification of Diet in Renal Disease (MDRD) equation to calculate estimated glomerular filtration rate (eGFR). The Chronic Kidney Disease-Epidemiology Collaboration Group (CKD-EPI) equation provides a more-accurate eGFR than the MDRD when compared against the radionuclide gold standard. The prevalence and prognostic import of renal dysfunction in HF if the CKD-EPI equation is used rather than the MDRD is uncertain. METHODS AND RESULTS: We used individual patient data from 25 prospective studies to stratify patients with HF by eGFR using the CKD-EPI and the MDRD equations and examined survival across eGFR strata. In 20 754 patients (15 962 with HF with reduced ejection fraction [HF-REF] and 4792 with HF with preserved ejection fraction [HF-PEF]; mean age, 68 years; deaths per 1000 patient-years, 151; 95% CI, 146-155), 10 589 (51%) and 11 422 (55%) had an eGFR <60 mL/min using the MDRD and CKD-EPI equations, respectively. Use of the CKD-EPI equation resulted in 3760 (18%) patients being reclassified into different eGFR risk strata; 3089 (82%) were placed in a lower eGFR category and exhibited higher all-cause mortality rates (net reclassification improvement with CKD-EPI, 3.7%; 95% CI, 1.5%-5.9%). Reduced eGFR was a stronger predictor of all-cause mortality in HF-REF than in HF-PEF. CONCLUSIONS: Use of the CKD-EPI rather than the MDRD equation to calculate eGFR leads to higher estimates of renal dysfunction in HF and a more-accurate categorization of mortality risk. Renal function is more closely related to outcomes in HF-REF than in HF-PEF.