Browsing by Subject "CKD-EPI formula"

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    Serum creatinine and cystatin C‐based estimates of glomerular filtration rate are misleading in acute heart failure
    (Wiley, 2021) Swolinsky, Jutta S.; Nerger, Niklas P.; Leistner, David M.; Edelmann, Frank; Knebel, Fabian; Tuvshinbat, Enkhtuvshin; Lemke, Caroline; Roehle, Robert; Haase, Michael; Costanzo, Maria Rosa; Rauch, Geraldine; Mitrovic, Veselin; Gasanin, Edis; Meier, Daniel; McCullough, Peter A.; Eckardt, Kai-Uwe; Molitoris, Bruce A.; Schmidt-Ott, Kai M.; Medicine, School of Medicine
    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 (r2 , 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.