title: Lack of concordance in defining worsening renal function by rise in creatinine vs rise in cystatin C.
abstract: Worsening renal function (WRF) during treatment of acute decompensated heart failure (ADHF) is generally associated with adverse outcomes. An increase ≥0.3 mg/dL in creatinine level is widely used as the definition of WRF. The authors sought to determine the level of agreement between WRF based on changes in creatinine and changes in cystatin C (CysC) by analyzing data from 121 ADHF patients with available admission and day 3 creatinine and CysC levels. Admission creatinine and CysC levels were 1.39 (0.98-2.11) mg/dL and 1.95 (1.42-2.69) mg/L, respectively, and correlated well (r=0.81). On average, creatinine (-0.04±0.40 mg/dL) and CysC (0.001±0.34 mg/L) changed minimally from admission to day 3. Although the correlation between both markers on day 3 was still good (r=0.79), the correlation between changes therein was only modest (r=0.43). From the 14 and 15 patients who had WRF based on a ≥0.3 mg/dL increase in creatinine and ≥0.3 mg/L increase in CysC, respectively, only four (about 30%) met both definitions. These observations, together with recent insights in the inconsistencies of creatinine-defined concept of worsening renal function and outcomes, raises the need to research more reliable measures of renal function during treatment of ADHF.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Matthias
authors.initials: M
authors.lastname: Dupont
authors.forename: Kevin
authors.initials: K
authors.lastname: Shrestha
authors.forename: Dhssraj
authors.initials: D
authors.lastname: Singh
authors.forename: Michael
authors.initials: M
authors.lastname: Finucan
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
mesh_terms: D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine