Key result
Evaluating heart transplant patients using eGFR rather than serum creatinine criteria identified a substantially higher prevalence of moderate (52.2% vs 24.9%) and severe (9.2% vs 6.7%) renal dysfunction.
Why the study?
Does eGFR-based grading compared to SCr-based grading alter the estimated prevalence and severity of renal dysfunction in stable adult heart transplant patients?
Cross-Sectional (n=1,062)
Yes
Does eGFR-based grading compared to SCr-based grading alter the estimated prevalence and severity of renal dysfunction in stable adult heart transplant patients?
eGFR-based grading reveals a significantly higher prevalence of moderate to severe renal dysfunction in heart transplant patients compared to direct serum creatinine grading, suggesting SCr alone is excessively insensitive.
Serum creatinine may underestimate renal dysfunction in heart transplant recipients; this Level 4 cross-sectional finding leaves open whether eGFR should guide monitoring.
Crespo‐Leiro MG, Delgado JF, Paniagua MJ, Vázquez, de Prada JA, Fernandez‐Yañez J, Almenar L, Diaz‐Molina B, Roig E, Arizón JM, Alonso‐Pulpón L, Garrido IP, Sanz ML, de la Fuente L, Mirabet S, Manito N, Muñiz J. Prevalence and severity of renal dysfunction among 1062 heart transplant patients according to criteria based on serum creatinine and estimated glomerular filtration rate: results from the CAPRI study. Clin Transplant 2010: 24: E88–E93. © 2009 John Wiley & Sons A/S. Abstract: Chronic kidney disease (CKD) is staged on the basis of glomerular filtration rate; generally, the MDRD study estimate, eGFR, is used. Renal dysfunction (RD) in heart transplant (HT) patients is often evaluated solely in terms of serum creatinine (SCr). In a cross‐sectional, 14‐center study of 1062 stable adult HT patients aged 59.1 ± 12.5 yr (82.3% men), RD was graded as absent‐or‐mild (AoM), moderate, or severe (this last including dialysis and kidney graft) by two classifications: SCr‐RD (SCr cutoffs 1.6 and 2.5 mg/dL) and eGFR‐RD (eGFR cutoffs 60 and 30 mL/min/1.73 m2). SCr‐RD was AoM in 68.5% of patients, moderate in 24.9%, and severe in 6.7%; eGFR‐RD, AoM in 38.6%, moderate in 52.2%, severe in 9.2%. Among patients evaluated <2.7, 2.7‐6.2, 6.2‐9.5 and >9.5 yr post‐HT (the periods defined by time‐since‐transplant quartiles), AoM/moderate/severe RD prevalences were <2.7, SCr‐RD 74/21/5%, eGFR‐RD 47/47/6%; 2.7‐6.2, SCr‐RD 73/22/5%, eGFR‐RD 37/56/7%; 6.2–9.5, SCr‐RD 69/24/7%, eGFR‐RD 37/54/9%; >9.5, SCr‐RD 58/32/10%, eGFR‐RD 32/52/16%. The prevalence of severe RD increases with time since transplant. If the usual CKD stages are appropriate for HT patients, the need for less nephrotoxic immunosuppressants and other renoprotective measures is greater than is suggested by direct SCr‐based grading, which should be abandoned as excessively insensitive.
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Crespo‐Leiro et al. (2009) conducted a cross-sectional in Heart transplant (n=1,062). eGFR-based criteria for renal dysfunction vs. Serum creatinine-based criteria was evaluated on Prevalence of severe renal dysfunction. Evaluating heart transplant patients using eGFR rather than serum creatinine criteria identified a substantially higher prevalence of moderate (52.2% vs 24.9%) and severe (9.2% vs 6.7%) renal dysfunction.
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