Creatinine Clearance and Hemoglobin Concentration Before and After Heart Transplantation Massimo Cirillo, Luca S. De Santo, Rosa Maria Pollastro, Giampaolo Romano, Ciro Mastroiacono, Ciro Maiello, Cristiano Amarelli, Enzo Di Stazio, Alessandra Perna, and Pietro Anastasio Clinical studies indicate that indices of glomerular filtration rate (GFR) as serum creatinine or creatinine clearance can predict the risk of death in congestive heart failure (CHF) and in heart transplantation. The study reports data on creatinine clear- ance before and after heart transplantation in 160 patients followed-up for 5 years at our Unit. Pre-transplant creatinine clearance averaged 83.532 mL/min  1.73 m 2 and was not significantly associated with 5-year mortality. Creatinine clearance significantly decreased after heart transplantation with a linear trend up to 3 years for patients with complete follow-up. Data suggest that the relation between kidney function and mor- tality after heart transplantation is affected by several confounders with inclusion of cause of heart disease, co-morbidity, anemia, and post-transplant decrease in kidney function. Semin Nephrol 25:413-418 © 2005 Elsevier Inc. All rights reserved. KEYWORDS Creatinine, glomerular filtration rate, congestive heart failure, heart transplanta- tion, mortality I t is interesting to note that data from the community cohort at Framingham did not assign any role for car- diovascular outcomes to kidney function in 2002. 1 In the same year, data from the National Health and Nutrition Examination Survey did not identify renal function as a risk factor for cardiovascular death. 2 However, an in- creased number of studies were performed recently to identify independent risk factors for mortality in heart failure. Available data indicate that reduced glomerular filtration rate (GFR) and anemia have emerged as indepen- dent risk factors for cardiovascular mortality. The Emergence of Estimated Creatinine Clearance as a Primary Risk Factor in Congestive Heart Failure Serum creatinine level was recognized as a prognostic marker in patients with congestive heart failure (CHF) without pro- viding evidence of an independent role. 3 When predicted creatinine clearance (CrCl) according to Cockroft and Gault 4 was used to measure GFR, as in a previous study, 3 it was shown that a GFR of less than 60 mL/min predicted pump- failure mortality and the combined end point of death or hospitalization. Therefore, the calculation of renal function started to be considered an integral part in the cure for CHF. 5 A significant step forward was made with the study of Departments of Nephrology and Heart Surgery, Second University of Na- ples, Naples, Italy. Supported by grants from Ministero dell’Istruzione, Università e Ricerca, Regione Campania, and the Second University of Naples to the Division of Heart Surgery and Nephrology at the Second University of Naples, Naples, Italy. Address reprint requests to Massimo Cirillo, MD, Chair of Nephrology, SUN, 5 Via Pansini, Pad 17, 80131 Naples, Italy. E-mail massimo.cirillo@unina2.it 413 0270-9295/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.semnephrol.2005.05.012