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Kidney Week

Abstract: PO0141

Estimated vs. Measured Glomerular Filtration Rate in Acute Decompensated Heart Failure

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Swolinsky, Jutta Sybille, Charité Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
  • Tuvshinbat, Enkhtuvshin, Charité Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
  • Knebel, Fabian, Charité Universitätsmedizin Berlin, Department of Cardiology and Angiology, Campus Mitte, Berlin, Germany
  • Nerger, Niklas P., Charité Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
  • Lemke, Caroline, Charité Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
  • Meier, Daniel, FAST Biomedical, Indianapolis, Indiana, United States
  • Gasanin, Edis, Kerckhoff-Klinik Department of Cardiology, Bad Nauheim, Hessen, Germany
  • Mitrovic, Veselin, Kerckhoff-Klinik Department of Cardiology, Bad Nauheim, Hessen, Germany
  • Eckardt, Kai-Uwe, Charité Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
  • Molitoris, Bruce A., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Schmidt-Ott, Kai M., Charité Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
Background

Kidney function is closely monitored in patients with acute decompensated heart failure (ADHF). Recent studies indicate that rise in endogenous filtration markers (serum creatinine (SCr) or cystatin c (Cys)), is neither associated with tubular injury nor with adverse outcomes when accompanied by efficient decongestion. The imperfections of SCr or Cys to estimate GFR in non-steady state could contribute to misjudgment of renal function in ADHF. In this study we measured GFR (mGFR) in patients treated for ADHF and correlated them with estimated GFR dynamics.

Methods

In a prospective cohort study in 50 hospitalized subjects treated for ADHF, GFR was measured using a two-component intravenous visible fluorescent injectate (VFI) at two timepoints 48h apart. Serum concentrations of a high molecular weight dextran component of VFI were measured 15 and 60 min after injection to quantify plasma volume (PV) using indicator-dilution principle. Concentrations of a low molecular weight component were measured to determine mGFR based on PV-normalized plasma pharmacokinetics. Pearson's r, Bland-Altman plots, precision, accuracy and bias were calculated for 4 established equations (CKD EPIScr, CKD EPICys, CKD EPIScr Cys, sMDRD) and kinetic GFR (kGFR, Chen et al., JASN 2013). 38 subjects had complete serial mGFR data.

Results

eGFR calculated by any estimating equation correlated significantly with measured GFR (CKD EPIScr, r=0.81; CKD EPICys, r=0.81.; CKD EPIScr Cys,r=0.84.; sMDRD, r=0.81; kGFR r=0.81, p<0.0001). CKD EPI Scr Cys had the best overall performance with an accuracy (P30) of 75%. However, changes in mGFR during 48h of ADHF treatment were not adequately reflected in corresponding changes of eGFR. KDIGO SCr-based AKI criteria frequently failed to detect relevant decreases of mGFR (Sensitivity 55%).

Conclusion

In patients hospitalized for ADHF undergoing decongestion, GFR estimates based on SCr and CC display substantial deficits in estimating GFR. In particular, changes of SCr- and CC- based GFR displayed a remarkable disconnect from mGFR dynamics. KDIGO SCr criteria displayed a poor sensitivity in detecting relevant decreases of mGFR, indicating a need for improved diagnostic approaches to identify true worsening renal function in ADHF.

Funding

  • Commercial Support