eGFR_cr and eGFR_cr-cys Show Similar Predictive Values for Incident Heart Failure

The risk prediction value for incident heart failure of race-independent creatinine and cystatin C-based estimated glomerular filtration rate (eGFR_cr-cys) is comparable to the race-dependent creatinine-based eGFR (eGFR_cr), according to a study in the Journal of Cardiac Failure.

The pooled cohort analysis obtained participant-level data from the Atherosclerosis Risk in Communities and the Multi-Ethnic Study of Atherosclerosis cohorts. The participants did not have history of cardiovascular disease and had cystatin C and creatinine data available.

The primary outcome was adjudicated incident heart failure during a 10-year follow-up. Multivariable adjusted Cox regression models were used to determine the 10-year risk for incident heart failure with eGFR overall and stratified by race.

A total of 15,615 individuals without prevalent cardiovascular risk were included in the study, of whom 45.0% were men and 23.9% were Black. The median age was 62 years. The participants had a median eGFR_cr-cys and eGFR_cr of 91.4 mL/min/1.73 m² and 84.7 mL/min/1.73 m², respectively. The first, second, third, and fourth quartiles of the eGFR_cr-cys were less than 79.4 mL/min/1.73 m², 79.4 to 91.4 mL/min/1.73 m², 91.4 to 102.0 mL/min/1.73 m², and greater than 102.0 mL/min/1.73 m², respectively.

Overall, 879 incident heart failure events occurred, for an incidence rate of 6.1 (95% CI, 5.8-6.6) events per 1000 person-years. The estimated risk for incident heart failure was increased with use of the eGFR_cr-cys vs the eGFR_cr of less than 90 mL/min/1.73 m².

The multivariable-adjusted risk for incident heart failure was 1.02 (95% CI, 0.80-1.30) in the third quartile, 1.02 (95% CI, 0.80-1.30) in the second quartile, and 1.47 (95% CI, 1.16-1.86) in the first quartile, using the highest quartile of eGFR_cr-cys as the reference group.

The adjusted hazard ratio for incident heart failure was 0.90 (95% CI, 0.73-1.12) in the third quartile, 0.96 (95% CI, 0.77-1.20) in the second quartile, and 1.15 (95% CI, 0.93-1.44) in the first quartile, with the highest quartile of eGFR_cr used as the reference group.

The C-index was 0.8029 (0.7886-0.8172) with the eGFR_cr and 0.8046 (0.7903-0.8189) with the eGFR_cr-cys in the Cox models for incident heart failure. For patients who were not Black, the C-index for Cox models predicting the risk for incident heart failure was 0.8077 (0.7908-0.8246) for the eGFR_cr and 0.8090 (0.7921-0.8259) for the eGFR_cr-cys.

In Black patients, the C-index for Cox models predicting the risk for incident heart failure was 0.7944 (0.7674-0.8214) with the eGFR_cr and 0.7976 (0.7709- 0.8243) with the eGFR_cr-cys.

The researchers noted that the study combined cohorts that were demographically and clinically different, and the validation cohorts had a limited number of Black individuals and insufficient representation of individuals who were not White or Black. In addition, the study did not stratify heart failure based on ejection fraction owing to limited data, and unmeasured residual confounding is possible.

“Widespread use of race-independent creatinine and cystatin C-based eGFR may help mitigate health disparities by improving access to heart failure therapy in previously ineligible individuals,” wrote the study authors.