Cargando…

Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate

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 el...

Descripción completa

Detalles Bibliográficos
Autores principales: Butt, Jawad H., Adamson, Carly, Docherty, Kieran F., Vaduganathan, Muthiah, Solomon, Scott D., Anand, Inder S., Zannad, Faiez, Køber, Lars, Jhund, Pardeep S., McMurray, John J.V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9467854/
https://www.ncbi.nlm.nih.gov/pubmed/35199418
http://dx.doi.org/10.1002/ejhf.2460
_version_ 1784788283734097920
author Butt, Jawad H.
Adamson, Carly
Docherty, Kieran F.
Vaduganathan, Muthiah
Solomon, Scott D.
Anand, Inder S.
Zannad, Faiez
Køber, Lars
Jhund, Pardeep S.
McMurray, John J.V.
author_facet Butt, Jawad H.
Adamson, Carly
Docherty, Kieran F.
Vaduganathan, Muthiah
Solomon, Scott D.
Anand, Inder S.
Zannad, Faiez
Køber, Lars
Jhund, Pardeep S.
McMurray, John J.V.
author_sort Butt, Jawad H.
collection PubMed
description 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; 9580 [22.2%] women). Mean eGFR was 67 (standard deviation [SD] 21) ml/min/1.73 m(2) and 70 (SD 21) ml/min/1.73 m(2) using the original and new CKD‐EPI equations, respectively (mean difference 3.20 ml/min/1.73 m(2), 95% confidence interval [CI] 3.17–3.23, p < 0.001). Of the 935 patients with chronic kidney disease (CKD) stages 4 or 5, identified using the original equation, 309 (33.0%) were reclassified to CKD stages 1–3 (eGFR ≥30 ml/min/1.73 m(2)) with the new equation. However, the opposite was observed among the 2521 Black patients (5.8%) included, with a reduction in mean eGFR from 75 to 68 ml/min/1.73 m(2) using the original and new equations, respectively (mean difference 6.94 ml/min/1.73 m(2), [95% CI 6.82–7.06], p < 0.001). The number of Black patients with an eGFR <30 ml/min/1.73 m(2) 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 proportion of patients with HFrEF enrolled in clinical trials. As eGFR is an essential 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 eligible Black patients.
format Online
Article
Text
id pubmed-9467854
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley & Sons, Ltd.
record_format MEDLINE/PubMed
spelling pubmed-94678542022-09-30 Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate Butt, Jawad H. Adamson, Carly Docherty, Kieran F. Vaduganathan, Muthiah Solomon, Scott D. Anand, Inder S. Zannad, Faiez Køber, Lars Jhund, Pardeep S. McMurray, John J.V. Eur J Heart Fail Drug Therapy in Real‐world Practice 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; 9580 [22.2%] women). Mean eGFR was 67 (standard deviation [SD] 21) ml/min/1.73 m(2) and 70 (SD 21) ml/min/1.73 m(2) using the original and new CKD‐EPI equations, respectively (mean difference 3.20 ml/min/1.73 m(2), 95% confidence interval [CI] 3.17–3.23, p < 0.001). Of the 935 patients with chronic kidney disease (CKD) stages 4 or 5, identified using the original equation, 309 (33.0%) were reclassified to CKD stages 1–3 (eGFR ≥30 ml/min/1.73 m(2)) with the new equation. However, the opposite was observed among the 2521 Black patients (5.8%) included, with a reduction in mean eGFR from 75 to 68 ml/min/1.73 m(2) using the original and new equations, respectively (mean difference 6.94 ml/min/1.73 m(2), [95% CI 6.82–7.06], p < 0.001). The number of Black patients with an eGFR <30 ml/min/1.73 m(2) 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 proportion of patients with HFrEF enrolled in clinical trials. As eGFR is an essential 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 eligible Black patients. John Wiley & Sons, Ltd. 2022-03-08 2022-05 /pmc/articles/PMC9467854/ /pubmed/35199418 http://dx.doi.org/10.1002/ejhf.2460 Text en © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Drug Therapy in Real‐world Practice
Butt, Jawad H.
Adamson, Carly
Docherty, Kieran F.
Vaduganathan, Muthiah
Solomon, Scott D.
Anand, Inder S.
Zannad, Faiez
Køber, Lars
Jhund, Pardeep S.
McMurray, John J.V.
Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate
title Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate
title_full Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate
title_fullStr Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate
title_full_unstemmed Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate
title_short Eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new Chronic Kidney Disease Epidemiology Collaboration creatinine equation for estimating glomerular filtration rate
title_sort eligibility for pharmacological therapies in heart failure with reduced ejection fraction: implications of the new chronic kidney disease epidemiology collaboration creatinine equation for estimating glomerular filtration rate
topic Drug Therapy in Real‐world Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9467854/
https://www.ncbi.nlm.nih.gov/pubmed/35199418
http://dx.doi.org/10.1002/ejhf.2460
work_keys_str_mv AT buttjawadh eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT adamsoncarly eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT dochertykieranf eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT vaduganathanmuthiah eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT solomonscottd eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT anandinders eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT zannadfaiez eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT køberlars eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT jhundpardeeps eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate
AT mcmurrayjohnjv eligibilityforpharmacologicaltherapiesinheartfailurewithreducedejectionfractionimplicationsofthenewchronickidneydiseaseepidemiologycollaborationcreatinineequationforestimatingglomerularfiltrationrate