Roth John, Lieske John C, Herrmann Sandra M, Arruda-Olson A M, Herrmann Joerg, McCallum Wendy, Larson Timothy S, Rule Andrew D, Titan Silvia M
Department of Internal Medicine, Mayo Clinic, Rochester, MN. (J.R.).
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. (J.C.L., S.M.H., T.S.L., A.D.R., S.M.T.).
Circ Heart Fail. 2025 Aug 15:e013014. doi: 10.1161/CIRCHEARTFAILURE.125.013014.
The performance of estimated glomerular filtration rate (eGFR) among patients with heart failure (HF) may be worse than in the general population due to a higher prevalence of confounding factors affecting creatinine and cystatin C. Studies in this area are scarce and not stratified by type of HF. We evaluated the performance of current creatinine and cystatin C equations (eGFRcr, eGFRcys, and eGFRcrcys) compared with measured GFR (mGFR) among patients with HF stratified by ejection fraction.
We pulled data on Mayo Clinic patients with an mGFR performed for clinical indications from 2011 to 2023, with serum creatinine and cystatin C measured within 7 days and an echocardiogram performed up to 1 year before the mGFR date. HF was identified by the presence of codes within 1 year before the mGFR and subgrouped into ejection fraction (EF) ≥50% (HFEF≥50%, n=182) or <50% (HFEF<50%, n=115) and compared with no-HF controls (n=1871). CKD-EPI (and EKFC) eGFRcr, eGFRcys, and eGFRcrcys equations were calculated and compared for bias (mGFR minus eGFR) and accuracy (1-P30, proportion of people with ≥30% difference between eGFR and mGFR). CIs were generated by bootstrapping.
The HF groups were characterized by older age, higher proportion of males, more diabetes, higher creatinine, and higher cystatin C than controls. In terms of bias, eGFRcr overestimated mGFR to a greater extent in both HF groups compared with controls, whereas eGFRcys and eGFRcrcys showed similar bias in both HF groups and controls. In the HF groups, cystatin C-based equations were more accurate than eGFRcr, particularly within HFEF<50% (1-P30 of 28% and 34% for CKD-EPI eGFRcys and eGFRcrcys, respectively, versus 60% for eGFRcr), whereas eGFRcrcys was more accurate in controls. The CKD-EPI and EKFC equations were overall convergent, showing similar results.
Among patients with HF, eGFRcr demonstrates inferior performance (more bias and less accuracy) compared with cystatin C-based eGFRs, with this effect being more pronounced in those with HFEF<50%.
由于影响肌酐和胱抑素C的混杂因素患病率较高，心力衰竭（HF）患者的估算肾小球滤过率（eGFR）表现可能比一般人群更差。该领域的研究较少，且未按心力衰竭类型分层。我们评估了目前基于肌酐和胱抑素C的方程（eGFRcr、eGFRcys和eGFRcrcys）与测量的肾小球滤过率（mGFR）在按射血分数分层的心力衰竭患者中的表现。
我们提取了梅奥诊所2011年至2023年因临床指征进行mGFR检测的患者数据，血清肌酐和胱抑素C在mGFR检测日期前7天内测量，超声心动图在mGFR检测日期前1年内进行。根据mGFR检测前1年内出现的编码确定心力衰竭，并将其分为射血分数（EF）≥50%（HFEF≥50%，n = 182）或<50%（HFEF<50%，n = 115）两组，并与无心力衰竭对照组（n = 1871）进行比较。计算CKD-EPI（和EKFC）eGFRcr、eGFRcys和eGFRcrcys方程，并比较其偏差（mGFR减去eGFR）和准确性（1-P30，即eGFR与mGFR差异≥30%的人群比例）。通过自抽样生成置信区间。
与对照组相比，心力衰竭组的特点是年龄较大、男性比例较高、糖尿病更多、肌酐和胱抑素C更高。在偏差方面，与对照组相比，eGFRcr在两个心力衰竭组中对mGFR的高估程度更大，而eGFRcys和eGFRcrcys在心力衰竭组和对照组中表现出相似的偏差。在心力衰竭组中，基于胱抑素C的方程比eGFRcr更准确，特别是在HFEF<50%的患者中（CKD-EPI eGFRcys和eGFRcrcys的1-P30分别为28%和34%，而eGFRcr为60%），而eGFRcrcys在对照组中更准确。CKD-EPI和EKFC方程总体上趋同，结果相似。
在心力衰竭患者中，与基于胱抑素C的eGFR相比，eGFRcr表现较差（偏差更大，准确性更低），这种影响在HFEF<50%的患者中更为明显。
