title: Renal biomarkers and outcomes in outpatients with heart failure: The Atlanta cardiomyopathy consortium.
abstract: OBJECTIVE
  Cystatin-C and beta-2-microglobulin may be superior to serum creatinine, blood urea nitrogen (BUN), or estimated glomerular filtration rate (eGFR) in patients hospitalized with heart failure (HF). We compared these renal markers in ambulatory HF patients.
  
  
  METHODS
  We prospectively evaluated the association of baseline renal markers and eGFR (by 4 different formulas) with (1) the composite of death or HF-related hospitalization and (2) rates of hospitalizations and emergency department (ED) visits in 166 outpatients with HF (57.3±11.6years; 57.2% white, 38.6% black, median left ventricular ejection fraction 27.5% [17.5, 40.0]).
  
  
  RESULTS
  After a median of 3.9years, 63 (38.0%) patients met the composite endpoint. There were 458 hospitalizations (177 [38.6%] for HF) and 209 ED visits (51 [24.4%] for HF). Cystatin-based eGFR most consistently predicted (1) the composite endpoint (highest-to-lowest tertile adjusted hazard ratio [HR] 4.92 [95% CI 2.07-11.7; P<0.001]); and (2) hospitalization rates, including HF hospitalizations (highest-to-lowest tertile, adjusted relative rate 5.24 [95% CI 1.61-17.01; P=0.006]). Serum creatinine alone was a strong predictor of the composite endpoint (highest-to-lowest tertile, adjusted HR 3.20 [95% CI, 1.51-6.78; P=0.002]). Only the highest tertile of BUN was associated with rates of ED visits.
  
  
  CONCLUSIONS
  In outpatients with HF, cystatin-based eGFR provides consistent prognostication across outcomes, except ED visits. Serum creatinine is an adequate prognosticator of death or HF hospitalization.
authors.affiliation: Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA, United States. Electronic address: vgeorgi@emory.edu.
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States.
authors.forename: W H Wilson
authors.initials: WHW
authors.lastname: Tang
authors.affiliation: Division of Cardiology, University of Thessaly, Larissa, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Giamouzis
authors.affiliation: Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA, United States.
authors.forename: Song
authors.initials: S
authors.lastname: Li
authors.affiliation: Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA, United States.
authors.forename: Anjan
authors.initials: A
authors.lastname: Deka
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.affiliation: Department of Cardiology, Stony Brook University, Stony Brook, NY, United States.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA, United States.
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015415:Biomarkers / Q000378:metabolism*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000378:metabolism; D055316:Cystatin C / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000378:metabolism / Q000473:pathology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D001613:beta 2-Microglobulin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D001613:beta 2-Microglobulin; D003404:Creatinine
keywords: Biomarkers; Heart failure; Outcomes; Renal function