Serum creatinine and cystatin C-based estimates of glomerular filtration rate are misleading in acute heart failure

被引：12

作者：

Swolinsky, Jutta S. ^{[1
,2
,3
]}

Nerger, Niklas P. ^{[1
,2
,3
]}

Leistner, David M. ^{[2
,4
,5
,6
,7
]}

Edelmann, Frank ^{[2
,4
,6
,7
]}

Knebel, Fabian ^{[2
,8
,9
,10
]}

Tuvshinbat, Enkhtuvshin ^{[1
,2
,3
]}

Lemke, Caroline ^{[1
,2
,3
]}

Roehle, Robert ^{[2
,6
,11
,12
]}

Haase, Michael ^{[13
]}

Costanzo, Maria Rosa ^{[14
]}

Rauch, Geraldine ^{[2
,6
,11
]}

Mitrovic, Veselin ^{[15
]}

Gasanin, Edis ^{[15
]}

Meier, Daniel ^{[16
]}

McCullough, Peter A. ^{[17
]}

Eckardt, Kai-Uwe ^{[1
,2
,3
]}

Molitoris, Bruce A. ^{[18
]}

Schmidt-Ott, Kai M. ^{[1
,2
,3
,6
,19
]}

机构：

[1] Charite Univ Med Berlin, Dept Nephrol & Med Intens Care, Hindenburgdamm 30, D-12203 Berlin, Germany

[2] Free Univ Berlin, Hindenburgdamm 30, D-12203 Berlin, Germany

[3] Humboldt Univ, Hindenburgdamm 30, D-12203 Berlin, Germany

[4] Charite Univ Med Berlin, Dept Internal Med & Cardiol, Berlin, Germany

[5] Humboldt Univ, Campus Benjamin Franklin, Berlin, Germany

[6] Charite Univ Med Berlin, Berlin Inst Hlth BIH, Clin Res Unit, Berlin, Germany

[7] Partner Site Berlin, DZHK German Ctr Cardiovasc Res, Berlin, Germany

[8] Humboldt Univ, Campus Virchow Klinikum, Berlin, Germany

[9] Charite Univ Med Berlin, Dept Cardiol & Angiol, Berlin, Germany

[10] Humboldt Univ, Campus Mitte, Berlin, Germany

[11] Charite Univ Med Berlin, Inst Biometry & Clin Epidemiol, Berlin, Germany

[12] Charite Univ Med Berlin, Coordinating Ctr Clin Studies, Berlin, Germany

[13] Otto von Guericke Univ, Fac Med, Magdeburg, Germany

[14] Advocate Heart Inst, Naperville, IL USA

[15] Kerckhoff Klin, Dept Cardiol, Bad Nauheim, Germany

[16] FAST BioMed, Indianapolis, IN USA

[17] Baylor Univ, Baylor Heart & Vasc Inst, Baylor Heart & Vasc Hosp, Med Ctr, Dallas, TX USA

[18] Indiana Univ, Sch Med, Indianapolis, IN USA

[19] Max Delbruck Ctr Mol Med Helmholtz Assoc, Berlin, Germany

来源：

ESC HEART FAILURE | 2021年 / 8卷 / 04期

关键词：

Acute heart failure; Worsening kidney function; Acute kidney injury; CKD-EPI formula; Measured GFR; Visible fluorescent injectate; WORSENING RENAL-FUNCTION; CHRONIC KIDNEY-DISEASE; EQUATION; HOSPITALIZATION; CACHEXIA; OUTCOMES; IMPACT; MUSCLE; INJURY; DIET;

D O I：

10.1002/ehf2.13404

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：3070 / 3081

页数：12

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