Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure

Gardner, Roy S.; Chong, Kwok S.; O’Meara, Eileen; Jardine, Alan G.; Ford, Ian; McDonagh, Theresa A.

doi:10.1093/eurheartj/ehm480

Cited by 30 publications

(27 citation statements)

References 27 publications

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“…Thus, in the study of Tsutamoto et al (6), HF patients with estimated GFR Ͻ40 ml/min and the highest BNP levels did indeed have higher median LV end-diastolic pressure compared with those with better preserved GFR. Such patients with presumed "cardiorenal syndrome" (26) may also have higher NP levels arising from advanced heart disease, greater preload, and multiple other comorbidities (27,28). Falsely low estimated GFR caused by poor renal perfusion or diuretic use in acute HF further complicate the relationship with NPs (5).…”

Section: Discussionmentioning

confidence: 99%

Natriuretic Peptides in Chronic Kidney Disease

Tagore

Ling

Yang

et al. 2008

Clinical Journal of the American Society of Nephrology

100

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Background and objectives: B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NTproBNP) are biomarkers of cardiovascular disease that is common in patients with chronic kidney disease (CKD). Conflicting data on the influence of glomerular filtration rate (GFR) on BNP and NT-proBNP levels in CKD may stem from failure to account fully for the effects of coexistent cardiac disease, dysfunction, and volume overload.Design, setting, participants, & measurements: Prospective head-to-head comparison of plasma BNP and NT-proBNP in ambulatory euvolemic CKD patients with normal LV ejection fraction and no manifest cardiac or vascular disease. GFR was estimated by the Modification of Diet in Renal Disease formula, BNP and NT-proBNP measured using Abbott AxSYM and Roche Elecsys assays, respectively, and cardiac morphology and function assessed by transthoracic echocardiography.Results: In 142 patients (42% female) of mean age 60 ؎ 11 yr, mean left ventricular ejection fraction was 71% ؎ 6%, GFR 38 ؎ 14 ml/min per 1.73 m 2 , and median BNP and NT-proBNP level 59 and 311 pg/ml, respectively. Multivariate predictors of NT-proBNP level were GFR, ␤-blocker usage, LV mass index, and hemoglobin level. Plasma BNP was independently predicted by LV mass index and ␤-blocker usage but not GFR. In the 74 patients without diastolic dysfunction, there was a significant rise in NT-proBNP but not BNP as GFR declined.Conclusions: Unlike NT-proBNP, plasma BNP level is relatively independent of GFR. BNP may therefore be the more appropriate biomarker to screen for cardiac dysfunction in CKD.

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Section: Discussionmentioning

confidence: 99%

Natriuretic Peptides in Chronic Kidney Disease

Tagore

Ling

Yang

et al. 2008

Clinical Journal of the American Society of Nephrology

100

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“…It is often quoted as a barometer of renal impairment, but it is actually a poor indicator of renal function. Therefore, estimation of the glomerular filtration rate (eGFR) is preferred for the accurate assessment of renal function 4,10 . The eGFR was determined by the abbreviated Modification of Diet in Renal Disease (MDRD) formula and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system 14 .…”

Section: Methodsmentioning

confidence: 99%

“…The eGFR was determined by the abbreviated Modification of Diet in Renal Disease (MDRD) formula and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system 14 . The abbreviated MDRD formula provides valid estimation of glomerular filtration rate (GFR) and according to recent findings it is superior to the CockcroftGault formula 4,[15][16][17][18] . According to the World Health Organization (WHO) anemia is defined as hemoglobin (Hb) concentration < 13.0 g/dL in men and < 12.0 g/dL in women 19 .…”

Section: Methodsmentioning

confidence: 99%

“…Renal insufficiency is directly associated with morbidity and mortality independent on established risk factors such as New York Heart Association (NYHA) class and left ventricle ejection fraction (LVEF) 2, 3 . Chronic heart failure is now seen not only as a cardiac disorder but rather a cardiorenal and neurohumoral syndrome which affects quality of life more profoundly than many other chronic diseases 4,5 .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure

et al. 2012

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Renal dysfunction is highly prevalent in the elderly CHF patients. It is associated with decreased functional capacity and therefore with poor prognosis. This study corroborates the use of eGFR not only as a powerful predictor of mortality in CHF, but also as an indicator of the functional capacity of cardiopulmonary system. However, clinicians underestimate a serial measurement of eGFR while it should be the part of a routine evaluation performed in every patient with CHF, particularly in the elderly population.

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“…Gardner et al reported that N-terminal prohormone brain natriuretic peptide (NT-proBNP) was a better prognostic marker than GFR from MDRD, among patients with advanced chronic heart failure. 19 Scrutinio et al 20 studied a population with normal serum creatinine and also demonstrated that the CG equation was better than MDRD for predicting heart failure-associated outcomes. The question of whether the greater sensitivity of MDRD for classifying advanced heart failure patients with renal failure reflects progressive decline in renal function or greater mortality among this population after heart transplantation remains to be addressed.…”

mentioning

confidence: 99%

Assessing glomerular filtration rate in patients with severe heart failure: comparison between creatinine-based formulas

Libório

Uchoa²,

Neto

et al. 2012

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure. DESIGN AND SETTING: Cross-sectional observational study at a university reference center. METHODS: GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis.RESULTS: This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m 2 ; P ≥ 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/ min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02). CONCLUSION: Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min. RESUMOCONTEXTO E OBJETIVO: Insuficiência cardíaca grave tem elevada correlação com doença renal crôni-ca. Creatinina sérica é um indicador pobre da função renal e a estimativa da taxa de filtração glomerular (TFG) é um método acessível para avaliar a função renal. As fórmulas mais populares estimadoras da TFG são a Cockcroft-Gault (CG), a modificação de dieta simplificada em doença renal (Simplified Modification of Diet in Renal Disease, sMDRD) com quatro variáveis, e a recentemente introduzida Colaboração Epidemiológica na Doença Renal Crônica (Chronic Kidney Disease-Epidemiology Collaboration, CKD--EPI). O objetivo foi analisar a correlação entre essas três equações estimadoras da TFG em pacientes com insuficiência cardíaca grave. ; P ≥ 0,05. Coeficiente de Pearson mostrou boa correlação entre todas as fór-mulas, assim como Bland-Altman. Entretanto, os pacientes apresentaram TFG < 60 ml/min mais frequentemente com a fórmula sMDRD (54,1% versus 40,2% para CG e 43,2% para CKD-EPI; P = 0,02). CONCLUSÃO: Apesar da boa correlação e concordância entre os três métodos, a fórmula do sMDRD classificou mais pacientes com TFG menor que 60 ml/min.

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Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure

Abstract: NT-proBNP appears superior to GFR estimated by MDRD in patients with advanced CHF. Moreover, NT-proBNP was able to identify patients with a poor prognosis whose GFR was already low.

Cited by 30 publications

References 27 publications

Natriuretic Peptides in Chronic Kidney Disease

Natriuretic Peptides in Chronic Kidney Disease

Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure

Assessing glomerular filtration rate in patients with severe heart failure: comparison between creatinine-based formulas

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