Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new CKD-EPI creatinine equation for estimating glomerular filtration rate

Butt, J. H., Adamson, C., Docherty, K. F. , Vaduganathan, M., Solomon, S. D., Anand, I. S., Zannad, F., Køber, L., Jhund, P. S. and McMurray, J. J.V. (2022) Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new CKD-EPI creatinine equation for estimating glomerular filtration rate. European Journal of Heart Failure, 24(5), pp. 861-866. (doi: 10.1002/ejhf.2460) (PMID:35199418)

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Abstract

Aims: The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimating glomerular filtration rate (eGFR), based on serum creatinine, that does not incorporate race may reclassify individuals, irrespective of race, from one eGFR category to another, with implications for eligibility for treatments in patients with heart failure and reduced ejection fraction (HFrEF). Methods and results: A total of 43,138 ambulatory patients with HFrEF from 12 clinical trials were included (mean age 64.3 years; 9,580 (22.2%) women). Mean eGFR was 67 (SD 21) ml/min/1.73m2 and 70 (SD 21) ml/min/1.73m2 using the original and new CKD-EPI equations, respectively (mean difference 3.20 [95%CI, 3.17-3.23] ml/min/1.73m2, P<0.001). Of the 935 patients with CKD stages 4 or 5, identified using the original equation, 309 (33.0%) were reclassified to CKD stages 1-3 (eGFR ≥30ml/min/1.73m2) with the new equation. However, the opposite was observed among the 2,521 Black patients (5.8%) included, with a reduction in mean eGFR from 75 to 68ml/min/1.73m2 using the original and new equations, respectively (mean difference 6.94 [95%CI, 6.82-7.06] ml/min/1.73m2, P<0.001). The number of Black patients with an eGFR<30ml/min/1.73m2 increased from 49 (1.9%) using the original equation to 71 (2.8%) with the new equation. Conclusions: The new CKD-EPI creatinine equation reclassified CKD stage in a large percentage of patients with HFrEF enrolled in clinical trials. As eGFR is a key determinant of eligibility for several key pharmacological therapies in HFrEF, this reclassification could result in a substantial change in the proportion of patients considered eligible for such therapies and reduce the proportion of Black patients eligible.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Adamson, Dr Carly and Butt, Mr Jawad and Docherty, Dr Kieran and Jhund, Dr Pardeep and McMurray, Professor John and Kober, Professor Lars
Authors: Butt, J. H., Adamson, C., Docherty, K. F., Vaduganathan, M., Solomon, S. D., Anand, I. S., Zannad, F., Køber, L., Jhund, P. S., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:23 February 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in European Journal of Heart Failure 24(5): 861-866
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science