title: Glomerular filtration rate (GFR) during and after STEMI: a single-centre, methodological study comparing estimated and measured GFR.
abstract: OBJECTIVE
  To validate the performance of the most commonly used formulas for estimation of glomerular filtration rate (GFR) against measured GFR during the index hospitalisation for ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  Single centre, methodological study.
  
  
  METHODS
  40 patients with percutaneous coronary intervention-treated STEMI were included between November 2011 and February 2013. Patients on dialysis, cardiogenic shock or known allergy to iodine were excluded.
  
  
  METHODS
  Creatinine and cystatin C were determined at admission and before discharge in 40 patients with STEMI. Clearance of iohexol was measured (mGFR) before discharge. We evaluated and compared the Cockcroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD-IDMS), the Chronic Kidney Disease Epidemiology (CKD-EPI) and the Grubb relative cystatin C (rG-CystC) with GFR regarding correlation, bias, precision and accuracy (P30). Agreement between eGFR and mGFR to discriminate CKD was assessed by Cohen's κ statistics.
  
  
  RESULTS
  MDRD-IDMS and CKD-EPI demonstrated good performance to estimate GFR (correlation 0.78 vs 0.81%, bias -1.3% vs 1.5%, precision 17.9 vs 17.1 mL/min 1.73 m(2) and P30 82.5% vs 82.5% for MDRD-IDMS vs CKD-EPI). CKD was best classified by CKD-EPI (κ 0.83). CG showed the worst performance (correlation 0.73%, bias -1% to 3%, precision 22.5 mL/min 1.73 m(2) and P30 75%). The rG-CystC formula had a marked bias of -17.8% and significantly underestimated mGFR (p=0.03). At arrival, CKD-EPI and rG-CystC had almost perfect agreement in CKD classification (κ=0.87), whereas at discharge agreement was substantially lower (κ=0.59) and showed a significant discrepancy in CKD classification (p=0.02). Median cystatin C concentration increased by 19%.
  
  
  CONCLUSIONS
  In acute STEMI, CKD-EPI showed the best CKD-classification ability followed by MDRD-IDMS, whereas CG performed the worst. STEMI altered the performance of the cystatin C equation during the acute phase, suggesting that other factors might be involved in the rise of cystatin C.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Venetsanos
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Alfredsson
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Segelmark
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Swahn
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Sofia Sederholm
authors.initials: SS
authors.lastname: Lawesson
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011184:Postoperative Period; D015995:Prevalence; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D013548:Sweden / Q000453:epidemiology
chemical_list: D055316:Cystatin C; D003404:Creatinine