Heart failure

Study measures discrimination in models that predict heart failure in patients with CRF


06 November 2021

1 min read

Source / Disclosures


Zelnick LR, et al. PaperTH-OR42. Presented at: ASN Kidney Week; Nov 4-7, 2021 (virtual meeting).

Disclosures: Zelnick reports editing for CJASN, consultant for the Veterans Medical Research Foundation and receiving support from the National Institute of Diabetes, Digestive and Kidney Diseases.

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Compared to other models, the N-terminal pro-brain natriuretic peptide is a low-load approach that offers “moderate discrimination” while predicting heart failure in patients with chronic kidney disease, according to the researchers. data from ASN Kidney Week.

“Patients with CRF have an approximately three times higher risk of heart failure [HF] compared to patients without CRF, both because they have a higher burden of traditional risk factors as well as factors specific to CRF that may contribute to heart failure ”, Leila R. Zelnick, PhD, from the University of Washington, said. “We evaluated the prognostic value of cardiac biomarkers and echocardiographic (echo) variables for the prediction of HF against a published clinical equation in the Chronic Kidney Disease Cohort [CRIC]. “

Using Cox regression analysis, Zelnick and colleagues compared the discrimination of the 11-variable Community Atherosclerosis Risk Prediction Equation (ARIC) to cardiac biomarkers and echo measurements. to estimate the risk of hospitalization for IC over 10 years. The study included 2,146 participants (mean age, 59 years; 53% male; 43% of them were black) of CRIC without prior CI and with complete clinical data on cardiac biomarkers and echo.

“For each model, we assessed the discriminating ability via the 10-fold cross-validated Harrell’s C index and assessed the calibration of the model both graphically and with the Grønnesby and Borgan test,” Zelnick said. “We assessed the discrimination with internally validated C indices and validated 10 times. “

During the 6.7 years of follow-up, 268 participants were hospitalized for CI.

The ARIC HF model with clinical variables had a C-index of 0.68. Likewise, high sensitivity troponin alone (C-index, 0.69) and left ventricular mass plus left ventricular ejection fraction (C-index, 0.71) were comparable to the ARIC model. However, the N-terminal pro-brain natriuretic peptide (NT-proBNP) alone had better discrimination (C-index, 0.72; P = .04).

“The ARIC heart failure prediction model for 10-year heart failure risk exhibited modest discrimination and poor calibration in this patient population. NT-proBNP and high-sensitivity troponin T together had moderate discrimination of the 0.73 point, which was similar to left ventricular mass and left ventricular ejection fraction alone, ”Zelnick said. “The addition of clinical variables further improved performance, and models that use these commonly measured cardiac biomarkers may provide a low-load approach to predict heart failure in CRF until prediction models d heart failure specific to CRF may be developed. “