Creatinine versus cystatin C to estimate glomerular filtration rate in adults with congenital heart disease: Results of the Boston Adult Congenital Heart Disease Biobank.
Am Heart J
; 214: 142-155, 2019 08.
Article
en En
| MEDLINE
| ID: mdl-31203159
ABSTRACT
BACKGROUND:
Glomerular filtration rate is a key physiologic variable with a central role in clinical decision making and a strong association with prognosis in diverse populations. Reduced estimated glomerular filtration rate (eGFR) is common among adults with congenital heart disease (ACHD).METHODS:
We conducted a prospective cohort study of outpatient ACHD ≥18â¯years old seen in 2012-2017. Creatinine and cystatin C were measured; eGFR was calculated using either the creatinine or cystatin C Chronic Kidney Disease-Epidemiology Collaboration equation (CKD-EPICr and CKD-EPICysC, respectively). Survival analysis was performed to define the relationship between eGFR and both all-cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization.RESULTS:
Our cohort included 911 ACHD (39⯱â¯14â¯years old, 49% female). Mean CKD-EPICr and CKD-EPICysC were similar (101⯱â¯20 vs 100⯱â¯23â¯mL/min/1.73 m2), but CKD-EPICr estimates were higher for patients with a Fontan circulation (nâ¯=â¯131, +10⯱â¯19â¯mL/min/1.73 m2). After mean follow-up of 659â¯days, 128 patients (14.1%) experienced the composite outcome and 31 (3.4%) died. CKD-EPICysC more strongly predicted all-cause mortality (eGFR <60 vs >90â¯mL/min/1.73 m2 CKD-EPICysC unadjusted HRâ¯=â¯20.2 [95% CI 7.6-53.1], C-statisticâ¯=â¯0.797; CKD-EPICr unadjusted HRâ¯=â¯4.6 [1.7-12.7], C-statisticâ¯=â¯0.620). CKD-EPICysC independently predicted the composite outcome, whereas CKD-EPICr did not (CKD-EPICysC adjusted HRâ¯=â¯3.0 [1.7-5.3]; CKD-EPICr adjusted HRâ¯=â¯1.5 [0.8-3.1]). Patients reclassified to a lower eGFR category by CKD-EPICysC, compared with CKD-EPICr, were at increased risk for the composite outcome (HRâ¯=â¯2.9 [2.0-4.3], Pâ¯<â¯.0001); those reclassified to a higher eGFR class were at lower risk (HRâ¯=â¯0.5 [0.3-0.9], Pâ¯=â¯.03).CONCLUSIONS:
Cystatin C-based eGFR more strongly predicts clinical events than creatinine-based eGFR in ACHD. Creatinine-based methods appear particularly questionable in the Fontan circulation.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_cardiovascular_diseases
/
6_congenital_chromosomal_anomalies
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6_other_circulatory_diseases
Asunto principal:
Creatinina
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Cistatina C
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Tasa de Filtración Glomerular
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Cardiopatías Congénitas
Tipo de estudio:
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Aspecto:
Patient_preference
Límite:
Adult
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Am Heart J
Año:
2019
Tipo del documento:
Article