Background: Impaired renal function has negative impact on cardiovascular outcome, and cardiorenal syndrome (CRS), with its five classes, encompasses the complex heart-kidney relationship. Although glomerular filtration rate (GFR) is considered the best overall index of kidney function, the topic is debated, since different formulae may provide different values in different groups of patients. Methods: We retrospectively investigated 438 adult Caucasian subjects admitted to an internal medicine unit. Mean age was 80±8 years, 50.6% males. CRS type 1 to 5 was diagnosed in 48.2%, 21.9%, 20.1%, 6.6%, and 3.2% of cases, respectively. Kidney function was evaluated by estimated GFR (eGFR) using the following equations: (a) Modification of Diet in Renal Disease MDRD186 (GFRMDRD186); (b) MDRD175 (GFRMDRD175); (c) Mayo Clinic Quadratic (GFRMAYO); (d) Chronic Kidney Disease Epidemiology Collaboration (GFR CDK-EPI); (e) Cockcroft-Gault (GFRC-G); and (f) Schaeffner’s equation (GFRBIS1) [3-4]. Duration of follow-up was 2.4±1.4 years, and the primary endpoint was all-cause mortality. Results: As for estimation of renal function in the different age subgroups, significant differences were given only by GFRC-G and GFRBIS1 formulae, with lower values in subjects aged >80 years and higher in those aged 60 years. Out of the 438 considered subjects, 144 deaths (38.7%) were recorded after a follow-up of 2.4±1.4 years. Deceased patients had a higher mean age compared with survivors (82±8 vs. 78±9, p<0.001), and showed lower GFR values as well (GFRMDRD186 30.7±12.3 vs. 36.4±12.7 ml/min/1.73 m2; GFRMDRD175 28.8±11.6 vs. 34.2±12; GFRMAYO 31.7±15.3 vs. 39±16.5; GFRCDK-EPI 27.4±11.4 vs. 33.2±12.3; GFRC-G 26.8±11.8 vs. 35±15.2; GFRBIS1 28.7±9.4 vs. 34.4±10.9, respectively, p<0.001 for all). ROC analysis showed that the area under the curve was similar using the different equations. Age (HR 1.047 [1.022-1.072]) and GFR were predictors of all-cause mortality, but for GFR the HR values calculated by the different equations were quite similar: GFRMDRD1860.973 [0.960-0.986]; GFRMDRD1750.971 [0.957-0.986]; GFRMAYO0.970 [0.956-0.985]; GFRCDK-EPI 0.971 [0.957-0.985]; GFRC-G0.979 [0.968-0.990]; GFRBIS1 0.963 [0.946-0.981] (p<0.001 for all). Conclusions: GFR calculation (with any equation) should always be performed in subjects admitted to internal medicine wards, since its close relationship with mortality.
Renal dysfunction and all-cause mortality in cardio-renal syndrome: calculation of glomerular filtration rate is crucial, independent of the equation.
FABBIAN, Fabio;Storari A.;MANFREDINI, Roberto
2013
Abstract
Background: Impaired renal function has negative impact on cardiovascular outcome, and cardiorenal syndrome (CRS), with its five classes, encompasses the complex heart-kidney relationship. Although glomerular filtration rate (GFR) is considered the best overall index of kidney function, the topic is debated, since different formulae may provide different values in different groups of patients. Methods: We retrospectively investigated 438 adult Caucasian subjects admitted to an internal medicine unit. Mean age was 80±8 years, 50.6% males. CRS type 1 to 5 was diagnosed in 48.2%, 21.9%, 20.1%, 6.6%, and 3.2% of cases, respectively. Kidney function was evaluated by estimated GFR (eGFR) using the following equations: (a) Modification of Diet in Renal Disease MDRD186 (GFRMDRD186); (b) MDRD175 (GFRMDRD175); (c) Mayo Clinic Quadratic (GFRMAYO); (d) Chronic Kidney Disease Epidemiology Collaboration (GFR CDK-EPI); (e) Cockcroft-Gault (GFRC-G); and (f) Schaeffner’s equation (GFRBIS1) [3-4]. Duration of follow-up was 2.4±1.4 years, and the primary endpoint was all-cause mortality. Results: As for estimation of renal function in the different age subgroups, significant differences were given only by GFRC-G and GFRBIS1 formulae, with lower values in subjects aged >80 years and higher in those aged 60 years. Out of the 438 considered subjects, 144 deaths (38.7%) were recorded after a follow-up of 2.4±1.4 years. Deceased patients had a higher mean age compared with survivors (82±8 vs. 78±9, p<0.001), and showed lower GFR values as well (GFRMDRD186 30.7±12.3 vs. 36.4±12.7 ml/min/1.73 m2; GFRMDRD175 28.8±11.6 vs. 34.2±12; GFRMAYO 31.7±15.3 vs. 39±16.5; GFRCDK-EPI 27.4±11.4 vs. 33.2±12.3; GFRC-G 26.8±11.8 vs. 35±15.2; GFRBIS1 28.7±9.4 vs. 34.4±10.9, respectively, p<0.001 for all). ROC analysis showed that the area under the curve was similar using the different equations. Age (HR 1.047 [1.022-1.072]) and GFR were predictors of all-cause mortality, but for GFR the HR values calculated by the different equations were quite similar: GFRMDRD1860.973 [0.960-0.986]; GFRMDRD1750.971 [0.957-0.986]; GFRMAYO0.970 [0.956-0.985]; GFRCDK-EPI 0.971 [0.957-0.985]; GFRC-G0.979 [0.968-0.990]; GFRBIS1 0.963 [0.946-0.981] (p<0.001 for all). Conclusions: GFR calculation (with any equation) should always be performed in subjects admitted to internal medicine wards, since its close relationship with mortality.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
