The Difference Between Cystatin C– and Creatinine-Based Estimated GFR in Heart Failure With Reduced Ejection Fraction: Insights From PARADIGM-HF

The Difference Between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate and Risk of Diabetic Microvascular Complications Among Adults With Diabetes: A Population-Based Cohort Study

“…For example, in 13,197 individuals in the Atherosclerosis Risk in Communities Study and in 158,601 adults in the Stockholm Creatinine Measurements project, large negative eGFRdiff was associated with higher risk of end-stage kidney disease and acute kidney injury ( 12 , 18 ). Similarly, large negative eGFRdiff has also been found to be associated with increased risk of worsening kidney function in patients with heart failure ( 13 ). To our knowledge, there are no published data exploring eGFRdiff and prognosis focusing on diabetes.…”

“…The estimated glomerular filtration rate (eGFR), usually measured by serum creatinine or cystatin C, is a widely used marker in medical practice to evaluate renal function and predict adverse prognosis in the diabetes population ( 8 ). The large intraindividual difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has gradually been recognized in recent years and is concerning, and it is reported to be associated with a range of adverse events, including falls, hospital admission, kidney failure, cardiovascular events, and mortality ( 9 – 13 ). To our best knowledge, no empirical data are currently available regarding the associations between the difference in eGFRcys and eGFRcr (eGFRdiff) and DMCs.…”

Latest pharmaceutical approaches across the spectrum of heart failure

“…While eGFR measured with creatinine has been largely used in the aforementioned trials to stratify patients with HF and impaired renal function as well as to guide the initiation and up-titration of GMDT, a discrepancy between eGFR measured with cystatin C and creatinine has already been described [ 77 , 78 ]. The use of cystatin C alone or in combination with creatinine is predictive of death as well as end-stage renal disease [ 77 ].…”

Association of Ratio of eGFR by Cystatin C and Creatinine with Mortality in Heart Failure

“… 2 Emerging data demonstrate that large intraindividual discrepancies between eGFRcr and eGFRcys are associated with adverse outcomes. 3 , 4 A ratio of eGFRcys/eGFRcr <0.7, indicating an intraindividual eGFRcys >30% lower than eGFRcr, has been associated with greater mortality risk in the general population. 3 In a post hoc analysis of the Prospective Comparison of ARNI [Angiotensin Receptor - Neprilysin Inhibitor] with ACEI [Angiotensin-Converting - Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial consisting of patients with predominantly moderate HFrEF, large discrepancies between eGFRcr and eGFRcys were associated with higher mortality.…”

“… 3 In a post hoc analysis of the Prospective Comparison of ARNI [Angiotensin Receptor - Neprilysin Inhibitor] with ACEI [Angiotensin-Converting - Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial consisting of patients with predominantly moderate HFrEF, large discrepancies between eGFRcr and eGFRcys were associated with higher mortality. 4 However, patients with an eGFR <30 ml/min per 1.73 m 2 were excluded. The prognostic ability of eGFRcr, eGFRcys, eGFR using weighted average of creatinine and cystatin C [eGFRcr-cys] (a weighted average of eGFRcr and eGFRcys), or eGFRcys/eGFRcr <0.7, indicating an intraindividual discrepancy of eGFRcys >30% lower than eGFRcr, have not been investigated in patients with advanced HFrEF across all CKD stages.…”