European Heart Journal Advance Access originally published online on October 29, 2007
European Heart Journal 2007 28(24):3027-3033; doi:10.1093/eurheartj/ehm480
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Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure
1 Department of Cardiology, Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK
2 Montreal Heart Institute, Quebec, Canada
3 Department of Nephrology, Western Infirmary, Glasgow, UK
4 Robertson Centre for Biostatistics, Glasgow University, Glasgow, UK
5 Department of Cardiology, Royal Brompton Hospital, UK
Received 31 March 2006; revised 27 August 2007; accepted 26 September 2007; online publish-ahead-of-print 29 October 2007.
* Corresponding author. Tel: +44 141 211 4000; fax: +44 141 211 4950. E-mail address: rsgardner{at}doctors.org.uk
See page 2960 for the editorial comment on this article (doi:10.1093/eurheartj/ehl399)
Aims: This study evaluates the prognostic utility of renal dysfunction estimated by the recently validated modification of diet in renal disease (MDRD) equations and compares it with the currently most promising predictor of prognosis in patients with advanced heart failure.
Methods and results: We prospectively studied 182 consecutive patients with advanced chronic heart failure (CHF) referred for consideration of cardiac transplantation, with a median follow-up of 642 days. Glomerular filtration rate (GFR) was estimated using the MDRD equations and plasma taken for NT-proBNP analysis. The primary endpoint of all-cause mortality was reached in 40 patients (13.2% crude 1-year mortality), and the combined secondary endpoint of all-cause mortality or urgent CTx was reached in 44 patients. The mean GFR estimated by MDRD-1 was 58 mL/min/1.73 m2. The median NT-proBNP concentration was 1505 (517–4014) pg/mL. Although GFR estimated by MDRD-1 was a univariate marker of all-cause mortality, the only predictor of either endpoint independent of other variables was an NT-proBNP concentration above the median.
Conclusion: NT-proBNP appears superior to GFR estimated by MDRD in patients with advanced CHF. Moreover, NT-proBNP was able to identify patients with a poor prognosis whose GFR was already low.
Key Words: Natriuretic peptides • Renal dysfunction • Prognosis • Heart failure
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