Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction
Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction
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DOI：
10.1161/circulationaha.105.610642
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发表时间：
2006-10-10
期刊：
影响因子：
37.8
通讯作者：
Hillege, Hans L.
中科院分区：
文献类型：
--
作者：
Smilde, Tom D. J.;van Veldhuisen, Dirk J.;Hillege, Hans L.
背景-肾功能是慢性心力衰竭（CHF）发病率和死亡率的一个重要风险标志，通常使用肌酐公式进行评估。然而，这些公式从未在广泛的CHF患者中得到验证。我们验证了3个常用的公式估计肾小球滤过率（GFR）与真实的GFR在CHF患者。此外，我们比较了这些公式的心血管预后的价值与真正的GFR在12个月的following.Methods和结果-在110 CHF患者（年龄，57 +/- 11.7岁，左心室射血分数，0.27 +/- 0.09，NYHA分级，2.5 +/- 0.9），我们测量了I-125-碘酞酸清除。使用Cockcroft-Gault（GFR（cg））、肾脏疾病饮食改良（MDRD）和简化MDRD（sMDRD）方程作为基于肌酐的肾功能估计值。此外，还测定了24小时肌酐清除率（CrCl）。CrCl和GFRcg最准确。MDRD是最精确的公式，尽管它也有很大的偏差。所有公式在经体表面积校正的GFR的下限范围内高估，在上限范围内低估。公式的预测性能在严重CHF（NYHA III和IV级）中最好。CrCl和MDRD的心血管预后价值是相媲美的GFR，sMDRD略少，GFR（CG）有一个显着更差的预后value.Conclusions -在更严重的范围内的CHF，肌酐为基础的公式和CrCl校正体表面积似乎是更精确和准确的估计真正的GFR校正体表面积。MDRD公式是最精确的，具有良好的预后价值，而sMDRD的准确性略低，但使用的参数较少，这使得该公式在临床实践中成为一种实用的替代方案。
Background - Renal function is an important risk marker for morbidity and mortality in chronic heart failure (CHF) and is often estimated with the use of creatinine-based formulas. However, these formulas have never been validated in a wide range of CHF patients. We validated 3 commonly used formulas estimating glomerular filtration rate (GFR) with true GFR in CHF patients. Furthermore, we compared the prognostic value of these formulas for cardiovascular outcome with that of true GFR during 12 months of follow-up.Methods and Results - In 110 CHF patients (age, 57 +/- 11.7 years; left ventricular ejection fraction, 0.27 +/- 0.09; NYHA class, 2.5 +/- 0.9), we measured I-125-iothalamate clearance. Cockcroft-Gault (GFR(cg)), Modification of Diet in Renal Disease (MDRD), and simplified MDRD (sMDRD) equations were used as creatinine-based renal function estimations. Furthermore, 24-hour creatinine clearance (CrCl) was determined. CrCl and GFRcg were the most accurate. MDRD was most precise formula, although it was also highly biased. All formulas overestimated in the lower ranges and underestimated in the upper ranges of the GFR corrected for body surface area. The predictive performance of the formulas was best in severe CHF (NYHA classes III and IV). The prognostic value of CrCl and MDRD for cardiovascular outcome was comparable to that of GFR, the sMDRD was slightly less, and the GFR(cg) had a significantly worse prognostic value.Conclusions - In the more severe ranges of CHF, creatinine-based formulas and CrCl corrected for body surface area appeared to be more precise and accurate in estimating true GFR corrected for body surface area. The MDRD formula is the most precise and has a good prognostic value, whereas the sMDRD is slightly less accurate but uses fewer parameters, which makes this formula a practical alternative in clinical practice.