Published Online
on October 2, 2006

A more recent version of this article appeared on October 10, 2006

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Submitted on December 28, 2005
Revised on August 1, 2006
Accepted on August 4, 2006

Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction

Tom D.J. Smilde MD, PhD, Dirk J. van Veldhuisen MD, PhD, Gerjan Navis MD, PhD, Adriaan A. Voors MD, PhD, and Hans L. Hillege MD, PhD^*

From the Departments of Cardiology (T.D.J.S, D.J.v.V., A.A.V., H.L.H.) and Nephrology (G.N.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

^* To whom correspondence should be addressed. E-mail: J.L.Hillege{at}tcc.umcg.nl.

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 ¹²⁵I-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 GFR_cg 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.

Key words: glomerular filtration rate • heart failure • prognostic value • renal function • validation

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