Original scientific paper
https://doi.org/10.3325/cmj.2015.56.531
Iohexol clearance is superior to creatinine-based renal function estimating equations in detecting short-term renal function decline in chronic heart failure
Katja Cvan Trobec
; Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
Mojca Kerec Kos
; Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
Stephan Haehling
; Innovative Clinical Trials Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
Stefan D. Anker
; Innovative Clinical Trials Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
Iain C. Macdougall
; Department of Renal Medicine, King’s College Hospital, Denmark Hill, London, UK
Piotr Ponikowski
; Medical University, Wroclaw, Poland
Mitja Lainscak
orcid.org/0000-0002-5922-4098
; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Abstract
Aim To compare the performance of iohexol plasma clearance
and creatinine-based renal function estimating equations
in monitoring longitudinal renal function changes in
chronic heart failure (CHF) patients, and to assess the effects
of body composition on the equation performance.
Methods Iohexol plasma clearance was measured in 43
CHF patients at baseline and after at least 6 months. Simultaneously,
renal function was estimated with five creatinine-
based equations (four- and six-variable Modification
of Diet in Renal Disease, Cockcroft-Gault, Cockcroft-Gault
adjusted for lean body mass, Chronic Kidney Disease Epidemiology
Collaboration equation) and body composition
was assessed using bioimpedance and dual-energy x-ray
absorptiometry.
Results Over a median follow-up of 7.5 months (range
6-17 months), iohexol clearance significantly declined
(52.8 vs 44.4 mL/[min ×1.73 m2], P = 0.001). This decline
was significantly higher in patients receiving mineralocorticoid
receptor antagonists at baseline (mean decline
-22% of baseline value vs -3%, P = 0.037). Mean serum creatinine
concentration did not change significantly during
follow-up and no creatinine-based renal function estimating
equation was able to detect the significant longitudinal
decline of renal function determined by iohexol clearance.
After accounting for body composition, the accuracy
of the equations improved, but not their ability to detect
renal function decline.
Conclusions Renal function measured with iohexol plasma
clearance showed relevant decline in CHF patients,
particularly in those treated with mineralocorticoid receptor
antagonists. None of the equations for renal function
estimation was able to detect these changes.
Keywords
Hrčak ID:
153077
URI
Publication date:
15.12.2015.
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