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| Item Type: | Article |
|---|---|
| Title: | Serum creatinine and cystatin C-based estimates of glomerular filtration rate are misleading in acute heart failure |
| Creators Name: | Swolinsky, J.S., Nerger, N.P., Leistner, D.M., Edelmann, F., Knebel, F., Tuvshinbat, E., Lemke, C., Roehle, R., Haase, M., Costanzo, M.R., Rauch, G., Mitrovic, V., Gasanin, E., Meier, D., McCullough, P.A., Eckardt, K.U., Molitoris, B.A. and Schmidt-Ott, K.M. |
| Abstract: | AIMS: We aimed to test whether the endogenous filtration markers serum creatinine or cystatin C and equation-based estimates of glomerular filtration rate (GFR) based on these markers appropriately reflect changes of measured GFR in patients with acute heart failure. METHODS: In this prospective cohort study of 50 hospitalized acute heart failure patients undergoing decongestive therapy, we applied an intravenous visible fluorescent injectate (VFI), consisting of a low molecular weight component to measure GFR and a high molecular weight component to correct for measured plasma volume. Thirty-eight patients had two sequential GFR measurements 48 h apart. The co-primary endpoints of the study were safety of VFI and plasma stability of the high molecular weight component. A key secondary endpoint was to compare changes in measured GFR (mGFR) to changes of serum creatinine, cystatin C and estimated GFR. RESULTS: VFI-based GFR measurements were safe and consistent with plasma stability of the high molecular weight component and glomerular filtration of the low molecular weight component. Filtration marker-based point estimates of GFR, when compared with mGFR, provided only moderate correlation (Pearson's r, range 0.80-0.88, depending on equation used), precision (r(2) , range 0.65-0.78) and accuracy (56%-74% of estimates scored within 30% of mGFR). Correlations of 48-h changes GFR estimates and changes of mGFR were significant (P < 0.05) but weak (Pearson's r, range 0.35-0.39). Observed decreases of eGFR by more than 15% had a low sensitivity (range 38%-46%, depending on equation used) in detecting true worsening mGFR, defined by a >15% decrease in mGFR. CONCLUSIONS: In patients hospitalized for acute heart failure, serum creatinine- and cystatin C-based predictions performed poorly in detecting actual changes of GFR. These data challenge current clinical strategies to evaluate dynamics of kidney function in acute heart failure. |
| Keywords: | Acute Heart Failure, Worsening Kidney Function, Acute Kidney Injury, CKD-EPI Formula, Measured GFR, Visible Fluorescent Injectate |
| Source: | ESC Heart Failure |
| ISSN: | 2055-5822 |
| Publisher: | Wiley |
| Volume: | 8 |
| Number: | 4 |
| Page Range: | 3070-3081 |
| Date: | August 2021 |
| Official Publication: | https://doi.org/10.1002/ehf2.13404 |
| PubMed: | View item in PubMed |
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