Mortality from renal dysfunction in heart transplant patients: creatinine versus glomerular filtration rate.
BACKGROUND
One of the most common, significant problems after heart transplantation (HT) is the development of renal dysfunction. In recent years, the glomerular filtration rate (GFR) has replaced the serum creatinine as the standard parameter for its determination. Our objective was to analyze which renal function parameter (creatinine or GFR) at 1 year after HT better classified patients who will die during follow-up.


METHODS
The study included 316 consecutive HT patients surviving at least 1 year after transplantation. Creatinine and GFR were determined by the Modification of Diet in Renal Disease Study (MDRD4) equation. Mortality during the follow-up was analyzed to compare both parameters using receiver operating characteristic curves.


RESULTS
Over a mean follow-up of 6±3 years, 97 patients died (30.7%). At 1 year after HT, the patients who succumbed displayed a significantly higher mean creatinine value (1.63±0.65 vs 1.41±0.64 mg/dL; P=.004) and a more decreased GFR (53.8 vs 60.8 mL/min/1.73 m2; P=.006). Both groups had the same area under the curve, 0.61 (95% confidence interval: 0.54-0.68; P=.002).


CONCLUSIONS
Among our population, GFR calculated by the abbreviated MDRD4 equation did not provide any additional prognostic value to serum creatinine at 1 year after HT to predict long-term mortality.
Heart Failure and Transplant Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain. villacampus@hotmail.com
J
J
Navarro-Manchón
L
L
Almenar Bonet
L
L
Martínez-Dolz
I
I
Sánchez-Lázaro
F
F
Buendía Fuentes
R
R
Raso Raso
J Agüero
JA
Ramon-Llín
M
M
Rodriguez-Serrano
E
E
Zorio Grima
A
A
Salvador Sanz
D000328:Adult; D019540:Area Under Curve; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology
D003404:Creatinine