Importance of cystatin C in estimating glomerular filtration rate: the PARADIGM-HF trial.

Autor:	Tolomeo P; BHF Glasgow Cardiovascular Research Centre (GCRC)126 University Place, Glasgow, G12 8TA.; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy., Butt JH; BHF Glasgow Cardiovascular Research Centre (GCRC)126 University Place, Glasgow, G12 8TA.; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Kondo T; BHF Glasgow Cardiovascular Research Centre (GCRC)126 University Place, Glasgow, G12 8TA.; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan., Campo G; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy., Desai AS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA., Jhund PS; BHF Glasgow Cardiovascular Research Centre (GCRC)126 University Place, Glasgow, G12 8TA., Køber L; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Lefkowitz MP; Novartis Pharmaceuticals, East Hanover, NJ, USA., Rouleau JL; Institut de Cardiologie de Montréal, Université de Montréal, Montreal, QC, Canada., Solomon SD; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA., Swedberg K; Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden., Vaduganathan M; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA., Zile MR; Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA., Packer M; Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA., McMurray JJV; BHF Glasgow Cardiovascular Research Centre (GCRC)126 University Place, Glasgow, G12 8TA.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2023 Jun 25; Vol. 44 (24), pp. 2202-2212.
DOI:	10.1093/eurheartj/ehad210
Abstrakt:	Aims: The 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation combining creatinine and cystatin C provides a better estimation of glomerular filtration rate (GFR) compared to the creatinine-only equation. Methods and Results: CKD-EPI creatinine-cystatin C equation (creatinine-cystatin) was compared to creatinine-only (creatinine) equation in a subpopulation of Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF). Patients were categorized according to difference in eGFR using the two equations: Group 1 (<-10 mL/min/1.73 m2, i.e. creatinine-cystatin more than 10 mL/min lower than creatinine), Group 2 (>-10 and <10 mL/min/1.73 m2), and Group 3 (>10 mL/min/1.73 m2, i.e. creatinine-cystatin more than 10 mL/min higher than creatinine). Cystatin C and creatinine were available in 1966 patients at randomization. Median (interquartile range) eGFR difference was -0.7 (-6.4-4.8) mL/min/1.73 m2. Compared to creatinine, creatinine-cystatin led to a substantial reclassification of chronic kidney disease stages. Overall, 212 (11%) and 355 (18%) patients were reallocated to a better and worse eGFR category, respectively. Compared to patients in Group 2, those in Group 1 (lower eGFR with creatinine-cystatin) had higher mortality and those in Group 3 (higher eGFR with creatinine-cystatin) had lower mortality. Increasing difference in eGFR (due to lower eGFR with creatinine-cystatin compared to creatinine) was associated with increasing elevation of biomarkers (including N-terminal pro-B-type natriuretic peptide and troponin) and worsening Kansas City Cardiomyopathy Questionnaire clinical summary score. The reason why the equations diverged with increasing severity of heart failure was that creatinine did not rise as steeply as cystatin C. Conclusion: The CKD-EPI creatinine-only equation may overestimate GFR in sicker patients. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01035255. Competing Interests: Conflict of interest J.H.B. reports advisory board honoraria from Bayer. A.S.D. reported receiving personal fees from Abbott, Biofourmis, Boston Scientific, Boehringer Ingelheim, Merck, Regeneron, and Relypsa and grants and personal fees from AstraZeneca, Alnylam, and Novartis outside the submitted work. L.K. reports personal fees from speaker honoraria from Novartis, AstraZeneca, Novo Nordisk, and Boehringer Ingelheim. M.P.L. is an employee of Novartis. J.L.R. has received grants and consulting fees from Novartis and consulting fees from Abbott, AstraZeneca, MyoKardia, and Sanofi. S.D.S. has received research grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lilly, Lone Star Heart, Mesoblast, MyoKardia, NIH/NHLBI, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, and Theracos and has consulted for Abbott, Action Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer-Ingelheim, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GSK, Ironwood, Lilly, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent. M.R.Z. has received research funding from Novartis and has been a consultant for Novartis, Abbott, Boston Scientific, CVRx, EBR, Endotronics, Ironwood, Merck, Medtronic, and Myokardia V Wave. M.P. has received consulting fees from AbbVie, Akcea, Actavis, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, Johnson & Johnson, Novo Nordisk, Pfizer, Relypsa, Sanofi, Synthetic Biologics, and Theravance. K.S. reports honoraria from Astrazeneca, Boerhinger-Mannheim, and Novartis. M.V. has received research grant support from or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Pharmacosmos, Relypsa, Roche Diagnostics, and Sanofi; has had speaker engagements with Novartis and Roche Diagnostics; and participates on clinical trial committees for studies sponsored by Bayer AG, Galmed, Occlutech, Novartis, and Impulse Dynamics. P.S.J. has received consulting fees, advisory board fees, and lecture fees from Novartis; advisory board fees from Cytokinetics; and grant support from Boehringer Ingelheim. T.K. received lecture fees from Abbott Medical Japan LLC., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Novartis Pharma K.K., AstraZeneca K.K., Bristol-Myers Squibb Co., and Abiomed Japan K.K. J.J.J.V.M. reports payments to his employer, Glasgow University, for work on clinical trials, consulting, lecturing, and other activities: Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Cardurion, Cytokinetics, Dal-Cor, GSK, Ionis, KBP Biosciences, Novartis, Pfizer, Theracos. Personal lecture fees: Abbott, Hikma, Sun Pharmaceuticals, Servier, Theracos; and personal payments from Abbott, Hikma, Ionis, Sun Pharmaceuticals, Servier. The other authors report no conflicts. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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