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Abstract: TH-PO1211

Lack of Concordance Between Changes in the Serum Creatinine and Measured GFR in Patients with Acute Decompensated Heart Failure

Session Information

Category: Acute Kidney Injury

Authors

  • Swolinsky, Jutta Sybille, Charité-Universitätsmedizin Berlin, Germany, Berlin, Germany
  • Tuvshinbat, Enkhtuvshin, Charité-Universitätsmedizin Berlin, Germany, Berlin, Germany
  • Knebel, Fabian, Charité Universitätsmedizin Berlin, Berlin, Germany
  • Gasanin, Edis, Kerckhoff-Klinik, Bad Nauheim, Germany
  • Meier, Daniel, FAST BioMedical, Carmel, Indiana, United States
  • Eckardt, Kai-Uwe, Charité-Universitätsmedizin Berlin, Germany, Berlin, Germany
  • Molitoris, Bruce A., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Schmidt-Ott, Kai M., Charité-Universitätsmedizin Berlin, Germany, Berlin, Germany
Background

The impact of serum creatinine-based episodes of acute kidney injury (AKI) on outcomes in patients with acute decompensated chronic heart failure (ADHF) is currently unknown. Unfortunately, creatinine and estimated GFR (eGFR) may not accurately reflect renal function under non-equilibrium conditions and might be affected by shifts in volume distributions in the context of decongestive therapy. In this study we measured plasma volume (PV) and GFR (mGFR) in patients undergoing treatment for ADHF and correlated them with creatinine dynamics and AKI based on KDIGO.

Methods

In a prospective cohort study in 50 hospitalized subjects with ADHF, PV and GFR were measured using a two-component intravenous visible fluorescent injectate (VFI) at two time points 48h apart during the course of treatment. Serum concentrations of a high molecular weight dextran component of VFI were measured 15, 60 and 180min after a single injection to quantify PV using the indicator-dilution principle. At the same time, concentrations of a low molecular weight dextran were measured to determine mGFR based on PV-normalized plasma pharmacokinetics. Linear correlation and Bland-Altman plots were used to compare changes in eGFR (CKD-EPI) and mGFR and to correlate changes in mGFR and eGFR. 38 patients had complete serial data regarding GFR dynamics during 48h of treatment.

Results

While eGFR and mGFR correlated well at the time of study inclusion (r=0,829, p<0,01), changes of eGFR and mGFR during 48h of ADHF treatment correlated poorly (r=0,3; p=0.08). 7 patients (18%) showed a decrease of mGFR by >=25% during 48h of treatment, but only one of these patients showed a corresponding decrease of creatinine-based eGFR by >=25%. Conversely, ten patients (26%) had a >=0.3mg/dl increase of creatinine within the 48h of treatment indicating a diagnosis of AKI by KDIGO, but only three of these patients (30%) had a decrease of mGFR by >=25%.

Conclusion

In patients hospitalized for ADHF undergoing recompensation, changes of measured GFR displayed a remarkable disconnect from estimated GFR predictions. Serum creatinine-based KDIGO AKI criteria frequently provided GFR-independent false-positive signals, indicating a need for improved diagnostics to identify worsening GFR in these patients.

Funding

  • Commercial Support