Prognostic Comparison of the Estimations of Renal Function in Patients With Acute Heart Failure

Background: The prognostic significance of the eGFR calculated by either the four-level Race Chronic Kidney Disease-Epidemiology Collaboration study equation (CKD-EPI4R) or the Chinese-modified Modification of Diet in Renal Disease equation (cMDRD) has not been compared in Asian populations with acute heart failure (AHF). Methods and Results: A total of 3,044 patients hospitalized for AHF were enrolled. The National Death Registry was linked to identify deaths within a 5-year follow-up. Net reclassification improvement (NRI) was calculated to compare the prognostic value of either eGFR equation. During a median follow-up of 23.3 months, 1,424 (47%) patients died. Both eGFR(cMDRD) and eGFR(CKD-EPI4R) were independently predictive of death in the total study population (hazard ratio and 95% confidence intervals per 1-SD: 0.76, 0.71-0.81 and 0.74, 0.70-0.79, respectively), and in the subgroups of either reduced (HFrEF) or preserved (HFpEF) ejection fraction, after accounting for important confounders. With reference to eGFR(cMDRD), eGFR(CKD-EPI4R) may improve the NRI by 2.0% (0.8-3.2%) for the prediction of death. The prognostic value of the CKD stages categorized by eGFR(CKD-EPI4R) significantly outperformed eGFR(cMDRD) with a categorical NRI of 9.5% (4.7-14.3%) in the total study population, 11.5% in HFrEF, and 8.3% in HFpEF. Conclusions: Both eGFR(cMDRD) and eGFR(CKD-EPI4R) were independently associated with long-term survival in patients with AHF. However, the CKD stages derived from eGFR(CKD-EPI4R) improved the risk stratification of death, compared with eGFR(cMDRD).