%0 Journal Article
%T Glomerular filtration rate (GFR) during and after STEMI: a single-centre, methodological study comparing estimated and measured GFR
%A Dimitrios Venetsanos
%A Eva Swahn
%A Joakim Alfredsson
%A M£¿rten Segelmark
%A Sofia Sederholm Lawesson
%J -
%D 2015
%R 10.1136/bmjopen-2015-007835
%X Objectives To validate the performance of the most commonly used formulas for estimation of glomerular filtration rate (GFR) against measured GFR during the index hospitalisation for ST-elevation myocardial infarction (STEMI).

Setting Single centre, methodological study.

Participants 40 patients with percutaneous coronary intervention-treated STEMI were included between November 2011 and February 2013. Patients on dialysis, cardiogenic shock or known allergy to iodine were excluded.

Outcome measures Creatinine and cystatin C were determined at admission and before discharge in 40 patients with STEMI. Clearance of iohexol was measured (mGFR) before discharge. We evaluated and compared the Cockcroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD-IDMS), the Chronic Kidney Disease Epidemiology (CKD-EPI) and the Grubb relative cystatin C (rG-CystC) with GFR regarding correlation, bias, precision and accuracy (P30). Agreement between eGFR and mGFR to discriminate CKD was assessed by Cohen's ¦Ê statistics.

Results MDRD-IDMS and CKD-EPI demonstrated good performance to estimate GFR (correlation 0.78 vs 0.81%, bias £¿1.3% vs 1.5%, precision 17.9 vs 17.1£¿mL/min 1.73£¿m2 and P30 82.5% vs 82.5% for MDRD-IDMS vs CKD-EPI). CKD was best classified by CKD-EPI (¦Ê 0.83). CG showed the worst performance (correlation 0.73%, bias £¿1% to 3%, precision 22.5£¿mL/min 1.73£¿m2 and P30 75%). The rG-CystC formula had a marked bias of £¿17.8% and significantly underestimated mGFR (p=0.03). At arrival, CKD-EPI and rG-CystC had almost perfect agreement in CKD classification (¦Ê=0.87), whereas at discharge agreement was substantially lower (¦Ê=0.59) and showed a significant discrepancy in CKD classification (p=0.02). Median cystatin C concentration increased by 19%.

Conclusions In acute STEMI, CKD-EPI showed the best CKD-classification ability followed by MDRD-IDMS, whereas CG performed the worst. STEMI altered the performance of the cystatin C equation during the acute phase, suggesting that other factors might be involved in the rise of cystatin C
%U https://bmjopen.bmj.com/content/5/9/e007835