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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

VERDEJO, Hugo et al. Estimation of renal function and mortality in congestive heart failure: a search for the best indicator. Rev Chil Cardiol [online]. 2014, vol.33, n.3, pp.189-197. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602014000300004.

Background. One of the best predictors of adverse events in patients with congestive heart failure (CHF) is the deterioration of renal function following hospitalization. Recent studies have questioned the usefulness of the Cockroft-Gault (CG) formula to estimate renal function in these patients. Aim: To evaluate the usefulness of different indirect methods for estimation of renal function in the prediction of late mortality in patients with CHF. Method: Consecutive patients admitted for CHF in 14 different hospitals from January 2002 and July 2012 were analyzed. Student’s t or Chi square were used as appropriate for statistical comparisons. The serum creatinine level at the time of discharge was used to estimate glomerular filtration rate (GFR) from 3 different formulae: CG, MDRD-4 and CKD-Epi. Agreement among methods for different assignment to different stages of renal failure was evaluated by the "kappa" statistics and the Bland- Altmann method. Survival according to the estimation from each formula was compared by the log-rank statistics on Kaplan-Meier’s survival curves. The ability of each formula to predict adverse events was evaluated by a Cox proportional hazards method. Mortality was obtained from de National Identification Registry. Results: 1548 patients were included, 45.3% of them females. Mean age was 70.5 years (SD 20). Creatinine level was 1,63±1,48 mg/dL at admission and 1,59±1,41 mg/dL at discharge (p=NS). The proportion of patients with renal failure ( creatinine clearance < 60ml/min/1.73 m2) was similar for all methods (CG: 57.3%, MDRD-4 54.9% and CKD-Epi 54.9%). Creatinine clearance by CG (59,4±30,4 mL/min/1,73m2) was higher than that estimated by CKD-EPI (54,2±25,1/1.73 m2) or MDRD-4 (57,8±27 mL/min/1,73m2). Both CKD-Epi and MDMD-4 correctly identified a subgroup of patients with lower late mortality (CKD-Epi quartiles 3 and 4, OR 0,5 IC95% 0,35-0,72; MDRD-4 quartiles 3 and 4, OR 0,56 IC95% 0,34-0,80). The CG formula did not identified subgroups with lower mortality rate. A cut point of 60 mL/min/1.73m2 (calculated by ROC analysis) determined a sensitivity of 0.63 and specificity of 0.43 for the CKD-Epi estimation and corresponding values of 0.60 and 0.45 for the MDRD-4 method Conclusion: GFR estimated by the MDRD-4 or the CKD-Epi methods allow the identification of a group of patients with a lower late mortality rate among patients with CHF in a simple, clinically useful way.

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