Incident Heart Failure Risk Reclassification With Race-Independent Estimated Glomerular Filtration Rate: A National Heart, Lung, and Blood Institute Pooled Cohorts Analysis

Background: This study compared the predictive value of the race-independent creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR_cr-cys) and the race-dependent creatinine-based eGFR (eGFR_cr) for incident heart failure (HF). Methods: This study combined the participant-level data from ARIC (Atherosclerosis Risk in Communities) (visit 4) and MESA (Multi-Ethnic Study of Atherosclerosis) (visit 1) to calculate eGFR_cr-cys and eGFR_cr. The primary outcome of the study was adjudicated incident HF over a follow-up period of 10 years. Multivariable Cox models were used to assess the risk of incident HF with the quartiles of eGFR_cr-cys and eGFR_cr. Results: Among 15,615 individuals (median age: 62 [57-68] years; 55.0% females; 23.9% Black), the median eGFR_cr-cys and eGFR_cr were 91.4 (79.4, 102.0) mL/min/1.73m² and 84.7 (72.0, 94.7) mL/min/1.73m², respectively. Compared with the fourth quartile of eGFR_cr-cys, the hazard ratio for incident HF 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. Compared with the 4th quartile of the eGFR_cr, the risk of incident HF was similar in the 3rd (HR_adj:0.90 [95% CI:0.73-1.12]), 2nd (HR_adj: 0.96 [95% CI:0.77–1.20]), and 1st (HR_adj:1.15 [95% CI:0.93–1.44]) quartiles. C-statistics were similar for the multivariable-adjusted Cox models for incident HF using eGFR_cr (0.80 [0.79–0.81]) and eGFR_cr-cys (0.80 [0.79–0.82]). Conclusion: The eGFR_cr and eGFR_cr-cys had comparable predictive values for incident HF.