title: Prognostic value of glomerular filtration rate estimation equations in acute heart failure with preserved versus reduced ejection fraction.
abstract: OBJECTIVE
  Renal function is an important prognostic factor in heart failure. The aim of this study was to compare the predictive value of estimated renal function calculated by the Chronic Kidney Disease-Epidemiology Collaboration equation (CKD-EPI) and the abbreviated Modification of Diet in Renal Disease (MDRD-4) equation for long-term all-cause mortality in patients admitted for acute decompensated heart failure (ADHF) with both preserved ejection fraction (HF-PEF) and reduced ejection fraction (HF-REF).
  
  
  RESULTS
  We evaluated patients included in the Spanish National Registry of Heart Failure (RICA). RICA is a multicentre, prospective, cohort study that included patients admitted to the Internal Medicine units with ADHF. Estimated glomerular filtration rate (eGFR) was calculated with CKD-EPI and MDRD-4 equations. A total of 1805 patients admitted for ADHF were studied (52% women; median age 80 years, interquartile range 73.9-84.6 years); of these, 1044 (58%) had HF-PEF. eGFR values were lower with the CKD-EPI formula than with the MDRD-4 formula (51 ml/min/1.73 m(2) vs. 55.7 ml/min/1.73 m(2) ; p < 0.001). The two formulas provided independent prognostic information over long-term follow-up, in both HF-PEF and HF-REF patients. However, in HF-PEF patients, CKD-EPI equation was associated with a significant improvement in reclassification analyses (net reclassification improvement 6.78%; p = 0.009).
  
  
  CONCLUSIONS
  In this clinical cohort of ADHF patients, eGFR as calculated by both the CKD-EPI and the MDRD-4 formulas offered similar prognostic information, irrespective of ejection fraction status, but in HF-PEF patients specifically, the CKD-EPI formula seems to improve clinical risk stratification as compared with MDRD-4.
authors: Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain.
authors: J
authors: J
authors: Casado Cerrada
authors: Internal Medicine Department, Hospital Juan Ramón Jiménez, Huelva, Spain.
authors: F J
authors: FJ
authors: Carrasco Sánchez
authors: Internal Medicine Department, Instituto de Investigación Sanitaria de Aragón, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors: J I
authors: JI
authors: Pérez-Calvo
authors: Heart Failure and Vascular Risk Unit, Department of Internal Medicine, University Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain.
authors: L
authors: L
authors: Manzano
authors: Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: F
authors: F
authors: Formiga
authors: Internal Medicine Department, Hospital Universitario Virgen Macarena de Sevilla, Sevilla, Spain.
authors: O
authors: O
authors: Aramburu Bodas
authors: Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
authors: A
authors: A
authors: Conde
authors: Internal Medicine Department, Hospital Costa del Sol, Marbella, Spain.
authors: R
authors: R
authors: Quirós
authors: Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Barcelona, Spain.
authors: C
authors: C
authors: Pérez Bocanegra
authors: Internal Medicine Deparment, IMIBIC/Hospital Reina Sofia de Córdoba, University of Córdoba, Córdoba, Spain.
authors: M
authors: M
authors: Montero-Pérez-Barquero
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*