Abstract: FR-OR54
Performance of Creatinine and Cystatin Equations in People with Heart Failure
Session Information
- Hypertension, CVD, and the Kidneys: Clinical Studies
October 25, 2024 | Location: Room 5, Convention Center
Abstract Time: 05:50 PM - 06:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Titan, Silvia, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Herrmann, Sandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Lieske, John C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Performance of eGFRs among patients with heart failure (HF) may be worse than in the average population, with implications for clinical care.
Methods
We retrieved cases with mGFR (urinary iothalamate) performed at Mayo Clinic between 2011-23 that had an echocardiogram performed within 1 year and serum creatinine (Cr Cohort) or Cr and cystatin (CrCysC Cohort) available within 7 days of the mGFR. Patients were then classified based on ICD codes for HF present 1 year prior to the mGFR and ejection fraction (< or >=50%). CKD-EPI and EKFC eGFRcr, eGFRcys, and eGFRcrcys were computed. Bias was defined as mGFR minus eGFR, and P30 as the proportion of people with eGFR >=30% difference to mGFR.
Results
Results are shown in Table 1. eGFRcr was the most biased equation, prone to overestimation of mGFR in HF groups compared to NoHF. eGFRcr also had the worst precision in the HF groups, with larger errors in HFrEF. eGFRcrcys was the most accurate in NoHF and HFpEF, while eGFRcysC was the most accurate in HFrEF. The CKD-EPI and EKFC performed similarly.
Conclusion
In people with HF, eGFRcr tends to overestimate mGFR and has worse precision compared to people without HF. eGFRcrcys was the most accurate in NoHF and HFpEF, while eGFRcys was the most accurate in the HFrEF group.
| Cr Cohort | CrCys Cohort | |||||
| NoHF (n=13131) | HFpEF (n=1517) | HFrEF (n=1011) | NoHF (n=1886) | HFpEF (n=184) | HFrEF (n=115) | |
| Median Bias (CI) | ||||||
| CKDEPIcr | 0.5 (0.2 , 0.8) | -3.7 (-4.7 , -2.8) | -4 (-5.1 , -3) | 0 (-0.6 , 0.9) | -6 (-8.1 , -4.5) | -8.1 (-11.4 , -4.4) |
| CKDEPIcys | - | - | - | 4.2 (3.3 , 5.3) | 4.7 (3.7 , 6.4) | 2.6 (-0.4 , 4.7) |
| CKDEPIcrcys | - | - | - | 1.1 (0.5 , 1.8) | 0.5 (-0.8 , 2.1) | -1.5 (-3.4 , 1.1) |
| EKFCcr | 6 (5.6 , 6.3) | 0.7 (0 , 1.7) | -0.5 (-1.6 , 0.4) | 5.1 (4.2 , 6) | -2.2 (-3.9 , -0.4) | -4 (-6.7 , -0.5) |
| EKFCcys | - | - | - | 3.3 (2.2 , 4.4) | 0.9 (-1.3 , 2.7) | -0.9 (-3.4 , 0.7) |
| EKFCcrcys | - | - | - | 4.1 (3.3 , 4.7) | -1.2 (-3.1 , -0.3) | -4.1 (-7.9 , -0.7) |
| 1 - P30 (CI) | ||||||
| CKDEPIcr | 22.4 (21.7 , 23.1) | 30.5 (28.1 , 32.8) | 37.6 (34.4 , 40.4) | 22.5 (20.6 , 24.4) | 35.9 (28.8 , 42.4) | 60 (51.3 , 68.7) |
| CKDEPIcys | - | - | - | 24.7 (22.7 , 26.6) | 32.1 (25.3 , 38.6) | 27.8 (20.5 , 36.1) |
| CKDEPIcrcys | - | - | - | 15.5 (14.0 , 17.2) | 25.0 (19.0 , 31.0) | 33.9 (26.1 , 42.6) |
| EKFCcr | 23.3 (22.5 , 24) | 27.9 (25.4 , 30.2) | 35 (32.2 , 37.8) | 22.9 (21.0 , 24.6) | 34.2 (27.2 , 42.1) | 58.3 (49.6 , 67.8) |
| EKFCcys | - | - | - | 20.8 (18.7 , 22.6) | 31 (23.9 , 38) | 33 (23.5 , 40.9) |
| EKFCcrcys | - | - | - | 15.4 (13.7 , 17.1) | 27.2 (19.6 , 33.4) | 39.1 (28.7 , 47) |
| RMSE | ||||||
| CKDEPIcr | 19.5 | 17.4 | 19.4 | 18.2 | 18.7 | 22.0 |
| CKDEPIcys | - | - | - | 19.2 | 16.1 | 13.4 |
| CKDEPIcrcys | - | - | - | 16.0 | 13.3 | 13.5 |
| EKFCcr | 20.7 | 16.3 | 18.0 | 19.3 | 16.6 | 19.6 |
| EKFCcys | - | - | - | 18.2 | 14.9 | 12.8 |
| EKFCcrcys | - | - | - | 17.0 | 13.2 | 13.8 |
| Bias was computed as mGFR - eGFR. Bias and RMSE are expressed as mL/min/1.73m2. | ||||||