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Renal dysfunction as a predictor of poor outcomes in older patients with heart failure: which formula to use?
Session:
Posters 5 - Écran 6 - Insuficiência Cardíaca
Speaker:
Maria Inês Fiúza Pires
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Inês Pires; Hugo Da Silva Antunes; Luísa Gonçalves; João Miguel Santos; Júlio Gil; Davide Moreira; José Costa Cabral; Inês Almeida
Abstract
<p>Introduction: Renal dysfunction (RD) is a predictor of adverse outcomes in heart failure (HF). There are several equations to estimate glomerular filtration rate (eGFR), namely the recent Berlin Initiative Study creatinine-based (BIS) formula, developed in ≥70 years old patients (P); the chronic kidney disease epidemiology collaboration creatinine-based (CKD-EPI) formula; and the Modification of Diet in Renal Disease (MDRD) formula. This study compares different eGFR equations in the prediction of adverse outcomes in older P with HF.</p> <p>Methods: All P with ≥70 years admitted for acute HF in a Cardiology Department during 7 years were included. Admission creatinine levels were used to calculate eGFR, using BIS, CKD-EPI and MDRD formulas. P were classified into normal renal function/mild RD if eGFR≥60mL/min/1.73m<sup>2</sup> or moderate/severe RD if eGFR<60mL/min/1.73m<sup>2</sup>. The follow-up (FU) was of 24 months. The primary endpoint (EP) was a composite of all-cause mortality or hospitalization for HF. Statistical analysis used chi-square, Mc Nemar and Mann-Whitney U tests; Kaplan-Meier curves and log-rank tests; Cox proportional hazards regression; and ROC curves to estimate the area under the curve (AUC) for the 3 eGFR formulas.</p> <p>Results: 815 P were studied (54.2% female, mean age 81.1±6.2 years). eGFR mean values as measured by the BIS, CKD-EPI and MDRD formulas were 45.95±16.59, 50.85±21.37 and 56.57±25.73 mL/min/1.73m<sup>2</sup>, respectively. The prevalence of eGFR<60mL/min/1.73m<sup>2</sup> was different with the 3 formulas: 80.6% with BIS, 66.7% with CKD-EPI and 60% with MDRD (p<0.001).</p> <p>Mortality during FU was 9.6%, and was associated with older age (p<0.001); chronic obstructive pulmonary disease (p<0.001); lower systolic blood pressure (p=0.005); lower hemoglobin (p=0.027) and albumin (p=0.021) levels; higher urea (p=0.049), potassium (p=0.012) and blood natriuretic peptide (p<0.001) levels. Mortality was associated with lower eGFR calculated with BIS (p=0.035), but not with CKD-EPI (p=0.096) or MDRD (p=0.152) equations. In survival analysis, there was a significant decrease in primary EP in P with eGFR≥60 mL/min/1.73m<sup>2</sup> using BIS (p=0.002), CKD-EPI (p<0.001) and MDRD (p=0.001) formulas. The unadjusted hazard ratio for reduction in primary EP was 0.984 (p<0.001) for BIS, 0.988 (p<0.001) for CKD-EPI and 0.991 (p=0.001) for MDRD. The BIS equation showed the best discriminatory power of the 3 formulas for prediction of both primary EP (AUC 0.609, 95% CI 0.566-0.650) and mortality during FU (AUC 0.574, 95% CI 0.531-0.616), and outperformed all other equations (p<0.001 in all comparisons).</p> <p>Conclusion: In this study, BIS eGFR equation was a predictor of primary EP and mortality during FU in older P with acute HF, and had the best predictive power, when compared to other commonly used formulas. Therefore, BIS should be considered to estimate renal function in these P, as its use could translate into better risk prediction.</p>
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