Tipping the scale toward a more accurate and equitable assessment of heart failure with reduced ejection fraction pharmacotherapy eligibility: a call to incorporate cystatin C in estimating glomerular filtration rate

Sinha, Arjun; Yancy, Clyde W.; Patel, Ravi B.

doi:10.1002/ejhf.2505

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…Despite the traditional reliance on sCr for kidney function assessment, two major nephrology societies have advocated for the routine use of cysC, citing its potential for greater accuracy and its independence from race 30 . Yancy et al have similarly endorsed wider implementation of cysC-based estimates in the care of patients with HF 31 . In a recent consensus statement on heart-kidney transplantation, Kobashigawa et al suggested the use of the CKD-EPI equation combining sCr and cysC 6 .…”

Section: Discussionmentioning

confidence: 99%

Kidney Function Assessment Using Cystatin C and Serum Creatinine in Heart Transplantation Recipients: Implications for Valganciclovir Dosing

Pinsino,

Jennings,

Ladanyi

et al. 2023

Preprint

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BackgroundAmong heart transplantation (HT) recipients, the accuracy of serum creatinine (sCr)-based estimated glomerular filtration rate (eGFR) may be limited by fluctuations in muscle mass. Cystatin C (cysC) is less influenced by muscle mass; however, its levels may increase with obesity and steroid use. Herein, we: i) longitudinally compared changes in eGFRcysC and eGFRsCr among HT recipients; ii) investigated the association of body mass index (BMI), steroid use and muscle mass with discrepancies between eGFRs; and iii) explored the implications of eGFRcysC use on valganciclovir (VGC) dosing.MethodscysC and sCr were measured in 294 blood samples obtained from 80 HT recipients. Intra-individual differences between eGFRs (eGFRdiffcysC-sCr) were calculated. Negative eGFRdiffcysC-sCrvalues correspond to eGFRsCr > eGFRcysC and positive values to eGFRcysC > eGFRsCr. In a patient subset (n=21), pectoralis muscle measures were derived from computed tomography scans.ResultsMarked differences between eGFRcysC and eGFRsCr were observed, particularly early post-HT (1-week post-HT, median eGFRdiffcysC-sCr−28 ml/min/1.73 m2). eGFRcysC demonstrated stability following a transient post-operative decline, while eGFRsCr decreased in the first year post-HT. Lower BMI and higher prednisone dose displayed a modest association with more negative eGFRdiffcysC-sCrvalues. Conversely, pectoralis muscle measures indicative of greater muscle mass and better tissue quality exhibited a stronger association with more positive eGFRdiffcysC-sCrvalues. eGFRcysC use would have resulted in VGC dose adjustment in 46% of samples, predominantly towards lower doses.ConclusionsAmong HT recipients, eGFRcysC and eGFRsCr markedly differ with implications for VGC dosing. The observed discrepancies may reflect changes in body composition and steroid use.

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Section: Discussionmentioning

confidence: 99%