Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany.
ESC Heart Fail. 2021 Aug;8(4):3070-3081. doi: 10.1002/ehf2.13404. Epub 2021 May 6.
We aimed to test whether the endogenous filtration markers serum creatinine or cystatin C and equation-based estimates of glomerular filtration rate (GFR) based on these markers appropriately reflect changes of measured GFR in patients with acute heart failure.
In this prospective cohort study of 50 hospitalized acute heart failure patients undergoing decongestive therapy, we applied an intravenous visible fluorescent injectate (VFI), consisting of a low molecular weight component to measure GFR and a high molecular weight component to correct for measured plasma volume. Thirty-eight patients had two sequential GFR measurements 48 h apart. The co-primary endpoints of the study were safety of VFI and plasma stability of the high molecular weight component. A key secondary endpoint was to compare changes in measured GFR (mGFR) to changes of serum creatinine, cystatin C and estimated GFR.
VFI-based GFR measurements were safe and consistent with plasma stability of the high molecular weight component and glomerular filtration of the low molecular weight component. Filtration marker-based point estimates of GFR, when compared with mGFR, provided only moderate correlation (Pearson's r, range 0.80-0.88, depending on equation used), precision (r , range 0.65-0.78) and accuracy (56%-74% of estimates scored within 30% of mGFR). Correlations of 48-h changes GFR estimates and changes of mGFR were significant (P < 0.05) but weak (Pearson's r, range 0.35-0.39). Observed decreases of eGFR by more than 15% had a low sensitivity (range 38%-46%, depending on equation used) in detecting true worsening mGFR, defined by a >15% decrease in mGFR.
In patients hospitalized for acute heart failure, serum creatinine- and cystatin C-based predictions performed poorly in detecting actual changes of GFR. These data challenge current clinical strategies to evaluate dynamics of kidney function in acute heart failure.
我们旨在检验血清肌酐或胱抑素 C 等内源性滤过标志物以及基于这些标志物的肾小球滤过率（GFR）估算方程能否准确反映急性心力衰竭患者 GFR 的变化。
在这项纳入 50 例接受利尿治疗的住院急性心力衰竭患者的前瞻性队列研究中，我们应用了一种静脉内可见荧光示踪剂（VFI），其中包含一个低分子量成分以测量 GFR，以及一个高分子量成分以校正测量的血浆容量。38 例患者在 48 小时内进行了两次连续的 GFR 测量。本研究的主要终点为 VFI 的安全性和高分子量成分的血浆稳定性。一个关键次要终点是比较测量的 GFR（mGFR）与血清肌酐、胱抑素 C 和估算的 GFR 的变化。
基于 VFI 的 GFR 测量是安全的，与高分子量成分的血浆稳定性和低分子量成分的肾小球滤过一致。与 mGFR 相比，滤过标志物的 GFR 点估计值仅提供了中等程度的相关性（Pearson r，范围为 0.80-0.88，取决于使用的方程）、精度（r ，范围为 0.65-0.78）和准确性（56%-74%的估计值与 mGFR 的差值在 30%以内）。48 小时 GFR 估计值的变化与 mGFR 的变化之间的相关性具有统计学意义（P<0.05），但较弱（Pearson r，范围为 0.35-0.39）。eGFR 下降超过 15%时，检测 mGFR 真正恶化的敏感性较低（范围为 38%-46%，取决于使用的方程），定义为 mGFR 下降超过 15%。
在因急性心力衰竭住院的患者中，血清肌酐和胱抑素 C 基于预测的 GFR 变化的检测性能不佳。这些数据对当前评估急性心力衰竭患者肾功能动态变化的临床策略提出了挑战。
