Elsevier

American Heart Journal

Volume 188, June 2017, Pages 189-195
American Heart Journal

Clinical Investigation
Clinical and prognostic value of spot urinary creatinine in chronic heart failure—An analysis from GISSI-HF

https://doi.org/10.1016/j.ahj.2017.01.017Get rights and content

Abstract

Objectives

This study aimed to identify patient characteristics associated with low urinary creatinine in morning spot urine and investigate its association with clinical outcome.

Background

Twenty-four-hour creatinine excretion is an established marker of muscle mass in heart failure and other populations. Spot urine creatinine might be an easy obtainable, cheap marker of muscle wasting and prognosis in heart failure (HF) patients.

Methods

Spot urine creatinine concentration was measured in 2130 patients included in the GISSI-HF trial. We evaluated the prognostic value of urinary creatinine and its relation with clinical variables.

Results

Median spot urinary creatinine was 0.80 (IQR 0.50-1.10) g/L. Lower spot urinary creatinine was associated with older age, smaller height and weight, higher NYHA class, worse renal function and more frequent spironolactone and diuretic use (all P < .02). During a median follow-up of 2.8 years, 655 patients (31%) experienced the combined endpoint of all-cause mortality or HF hospitalization. Lower urinary creatinine was independently associated with an increased risk of all-cause mortality or HF hospitalization (HR, 1.59 [1.21-2.08] per log decrease, P = .001), and all-cause mortality (HR, 1.75 [1.25-2.45] per log decrease, P = .001).

Conclusion

Lower urinary creatinine, measured in morning spot urine in patients with chronic HF, is associated with worse renal function, smaller body size, more severe HF and is independently associated with an increased risk of all-cause death and HF hospitalization.

Section snippets

Patient population and study design

The study population has been described in detail previously.10., 11. In short, 6975 heart failure patients (New York Heart Association [NYHA] II-IV) were included in the GISSI-HF, a randomized, double-blind, placebo-controlled, multicenter study. Patients were randomized to n-3 PUFA 1 g daily or placebo and if eligible to rosuvastatin 10 mg daily or placebo. All patients provided written informed consent and the trial was approved by the local ethics committee at each participating site. This

Results

Baseline characteristics per quartile of urinary creatinine are presented in Table I. Median urinary creatinine was 0.80 (IQR, 0.50 to 1.10) g/L, and was significantly higher in men (0.80 (IQR, 0.50-1.20) g/L) compared with women (0.70 (IQR, 0.40-1.00) g/L (P < .001). Patients with a low urinary creatinine (lower quartile, Q1) were older, more often female and had more severe heart failure (all P < .001). Patients in the highest quartile (Q4) were heavier and taller, without a significant

Discussion

In this study in patients with chronic heart failure we demonstrated that a lower urinary creatinine, measured in morning spot urine, was associated with worse renal function, more severe heart failure and was independently associated with an increased risk of all-cause mortality and heart failure hospitalization.

The 24-hour urinary creatinine excretion rate is an established method of estimating muscle mass, and standardized methods of muscle mass (such as CT or MRI) are highly correlated with

Conclusion

Lower urinary creatinine, measured in morning spot urine in patients with chronic heart failure, is associated with worse renal function, smaller body stature, and more severe heart failure and is independently associated with an increased risk of adverse clinical outcome.

Funding

GISSI is endorsed by Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; by Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; and by Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy. SPA, Pfizer, Sigma Tau, and AstraZeneca concurred to fund the main study. AstraZeneca provided separate support for this substudy.

Disclosures

A.P.M., R.L., S.M., and G.T. report having received institutional grants from AstraZeneca, SPA, SigmaTau, Pfizer. A.P.M. reports having received honoraria for lectures from AstraZeneca. L.T. reports having served on speakers bureaus from companies that financed the GISSI-HF trail. J.M.t.M., S.S., A.A.V., and K.D. have no conflicts of interest to disclose in relation to this manuscript.

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Trial registration: ClinicalTrials.gov NCT00336336

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