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Overestimation of Renal Function Using Serum Creatinine in the Advanced Heart Failure Population: A Call for Alternative Measures

Published:November 03, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.10.428
      The Kidney Disease Improving Global Outcome guidelines recommend the use of cystatin-C over serum creatinine in patients with muscle wasting conditions [
      • Stevens PE
      • Levin A
      • Disease Kidney
      Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group M. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline.
      ]. Muscle wasting is common in heart failure (HF), however HF guidelines and have not yet shifted away from the use of serum creatinine to estimate renal function [
      • Heidenreich PA
      • Bozkurt B
      • Aguilar D
      • Allen LA
      • Byun JJ
      • Colvin MM
      • et al.
      2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
      ]. A recent prospective left ventricular assist device (LVAD) cohort analysis found that 52 % of LVAD recipients were sarcopenic prior to implantation, with a gain of 2.3 kg change in fat free mass (ie muscle) by dual X-ray absorptiometry in the first 3 months after LVAD implantation [
      • Vest AR
      • Wong WW
      • Chery J
      • Coston A
      • Telfer L
      • Lawrence M
      • et al.
      Skeletal Muscle Mass Recovery Early After Left Ventricular Assist Device Implantation in Patients With Advanced Systolic Heart Failure.
      ]. In another LVAD cohort, serial cystatin-C and creatinine measurements over time suggested overestimation of renal function using serum creatinine in the post-operative period due to muscle wasting [
      • Pinsino A
      • Mondellini GM
      • Royzman EA
      • Hoffman KL
      • D'Angelo D
      • Mabasa M
      • et al.
      Cystatin C- Versus Creatinine-Based Assessment of Renal Function and Prediction of Early Outcomes Among Patients With a Left Ventricular Assist Device.
      ]. In this analysis, we build on this work by using a single center, well characterized advanced heart failure (AHF) cohort with pre-operative quantitative thoracic muscle measurements, cystatin-C, and serial BMI and creatinine values to investigate the hypotheses that 1) BMI decreases prior to LVAD and this decrease will be associated with thoracic muscle mass and quality 2) that pre-LVAD serum cystatin-C and creatinine will differ significantly and 3) post LVAD BMI and creatinine estimated glomerular filtration rate (eGFR) trends will be inversely related (creatinine will rise as body weight increases). If these hypotheses are true, this would support the need for alternative, non-muscle dependent measures of renal function in the AHF population.

      Key Words

      Abbreviations:

      AHF (advanced heart failure), BMI (body mass index), eGFR (estimated glomerular filtration rate), HF (heart failure), LVAD (left ventricular assist device)
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