title: Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Tom D J
authors.initials: TD
authors.lastname: Smilde
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
mesh_terms: D000368:Aged; D001830:Body Surface Area; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000503:physiopathology* / Q000652:urine*; D002908:Chronic Disease; D003404:Creatinine / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007483:Iothalamic Acid / Q000378:metabolism; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine; D007677:Kidney Function Tests; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013599:Systole / Q000502:physiology
chemical_list: D007483:Iothalamic Acid; D003404:Creatinine