The difference between cystatin C- and creatinine-based assessment of kidney function in acute heart failure

Alberto Pinsino, Matteo Fabbri, Lorenzo Braghieri, Bruno Bohn, Antonia J. Gaudig, Andrea Kim, Koji Takeda, Yoshifumi Naka, Gabriel T. Sayer, Nir Uriel, Ryan T. Demmer, Robert T. Faillace, Syed A. Husain, Sumit Mohan, Paolo C. Colombo, Melana Yuzefpolskaya

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Aims: Acute heart failure (HF) is associated with muscle mass loss, potentially leading to overestimation of kidney function using serum creatinine-based estimated glomerular filtration rate (eGFRsCr). Cystatin C-based eGFR (eGFRCysC) is less muscle mass dependent. Changes in the difference between eGFRCysC and eGFRsCr may reflect muscle mass loss. We investigated the difference between eGFRCysC and eGFRsCr and its association with clinical outcomes in acute HF patients. Methods and results: A post hoc analysis was performed in 841 patients enrolled in three trials: Diuretic Optimization Strategy Evaluation (DOSE), Renal Optimization Strategies Evaluation (ROSE), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF). Intra-individual differences between eGFRs (eGFRdiff) were calculated as eGFRCysC–eGFRsCr at serial time points during HF admission. We investigated associations of (i) change in eGFRdiff between baseline and day 3 or 4 with readmission-free survival up to day 60; (ii) index hospitalization length of stay (LOS) and readmission with eGFRdiff at day 60. eGFRCysC reclassified 40% of samples to more advanced kidney dysfunction. Median eGFRdiff was −4 [−11 to 1.5] mL/min/1.73 m2 at baseline, became more negative during admission and remained significantly different at day 60. The change in eGFRdiff between baseline and day 3 or 4 was associated with readmission-free survival (adjusted hazard ratio per standard deviation decrease in eGFRdiff: 1.14, P = 0.035). Longer index hospitalization LOS and readmission were associated with more negative eGFRdiff at day 60 (both P ≤ 0.026 in adjusted models). Conclusions: In acute HF, a marked difference between eGFRCysC and eGFRsCr is present at baseline, becomes more pronounced during hospitalization, and is sustained at 60 day follow-up. The change in eGFRdiff during HF admission and eGFRdiff at day 60 are associated with clinical outcomes.

Original languageEnglish (US)
Pages (from-to)3139-3148
Number of pages10
JournalESC Heart Failure
Volume9
Issue number5
DOIs
StatePublished - Oct 2022

Bibliographical note

Funding Information:
This publication was supported from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University. This manuscript was prepared using datasets obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center and does not necessarily reflect the opinions or views of the NHLBI or the study investigators.

Funding Information:
Y.N. serves as a consultant for Abbott. G.T.S. serves as a consultant for Abbott. N.U. has received research grant support and consultant fees from Abbott and Medtronic. P.C.C. has received research grant support from Abbott and serves as a consultant for the same company. The remaining authors have no conflict of interest to declare.

Funding Information:
This publication was supported from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York‐Presbyterian Hospital/Columbia University.

Publisher Copyright:
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords

  • Acute heart failure
  • Cardiorenal syndrome
  • Cystatin C
  • Glomerular filtration rate

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