Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 May;18(3):258-63.
doi: 10.1097/mnh.0b013e328326f3dd.

Association of cystatin C with adverse outcomes

Magdalena Madero  1 , Mark J Sarnak
Affiliations
Review

Association of cystatin C with adverse outcomes

Magdalena Madero et al. Curr Opin Nephrol Hypertens. 2009 May.

Abstract

Purpose of review: To discuss recent studies which have evaluated determinants of cystatin C and to focus on the relationship of cystatin C with mortality, cardiovascular disease (CVD), and noncardiovascular outcomes.

Recent findings: In the Chronic Kidney Disease Epidemiology Study cystatin C was associated with demographic characteristics independent of measured glomerular filtration rate (GFR), although this was to a smaller extent than creatinine. In patients with established chronic kidney disease (CKD), cystatin C was strongly and inversely correlated with measured GFR, suggesting that although cystatin C may have other determinants, it is primarily a measure of kidney function. Several cohort studies, particularly in older adults, have now demonstrated that cystatin C is linearly associated with mortality, CVD and non-CVD outcomes, whereas creatinine is primarily associated with risk in individuals with more advanced kidney disease. A recent study has also shown that changes in kidney function as ascertained by cystatin C, even within the relatively normal range, are associated with subsequent CVD and all-cause mortality among older adults.

Summary: Cystatin C appears to capture an association of mild kidney disease with increased risk of mortality, CVD and non-CVD outcomes. Future studies should evaluate whether cystatin C can improve medical decision-making and lead to favorable patient outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Correlations between 1/cystatin C and measured glomerular filtration rate (GFR) (top) and 1/serum creatinine (bottom) Reproduced with permission from Menon, V, Shlipak, M Wang, X et al. Cystatin C as a risk factor for outcomes in CKD. Ann Intern Med 147 :19-27,2007
Figure 2
Figure 2
Incident hypertension rates within quartiles of serum cystatin C and sex-specific urinary albumin–creatinine ratio Rates are adjusted for sex, age and race Reproduced with permission from Kestenbaum, B, Rudser, K, de Boer, I et al. Differences in Kidney Function and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis. Ann Intern Med 148 (7): 501-508, 2008
Figure 3
Figure 3
Smoothed spline of expected successful life years and baseline cystatin C level. Pointwise 95% confidence intervals (dashed lines) and a rug of the middle 95% of cystatin C measures are shown Reproduced with permission from Sarnak M, Katz, R, Fried L et al. Cystatin C and Aging Success. Arch Intern Med. 168(2):147-153,2008
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Köttgen A, Selvin E, Stevens LA, et al. Serum cystatin C in the United States: The Third National Health and Nutrition Examination Survey (NHANES III) Am J Kidney Dis. 2008;51:385–394. This analysis from the Third National Health and Nutrition Examination Survey (NHANES III) evaluates the determinants of cystatin C across a wide age range and different ethnicities. Serum cystatin C level was related to sex and ethnicity, even in young healthy individuals. The prevalence of increased cystatin C levels increased dramatically with age, reaching greater than 50% after the age of 80 years in both sexes and all ethnic groups. - PubMed
    1. Stevens LA, Coresh J, Schmid CH, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: A pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008;51:395–406. In a pooled analyses of 3,418 individuals with CKD (mean GFR 48 ml/min/1.73 m2), serum cystatin C level alone provided GFR estimates that were nearly as accurate as serum creatinine level adjusted for age, sex, and race. An equation including serum cystatin C level in combination with serum creatinine level, age, sex, and race provided the most accurate estimate of GFR. - PMC - PubMed
    1. Knight EL, Verhave JC, Spiegelman D, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65:1416–1421. - PubMed
    1. Manetti L, Pardini E, Genovesi M, et al. Thyroid function differently affects serum cystatin C and creatinine concentrations. J Endocrinol Invest. 2005;28(4):346–9. 2005. - PubMed
    1. Risch L, Herklotz R, Blumberg A, et al. Effects of glucocorticoid immunosuppression on serum cystatin C concentrations in renal transplant patients. Clin Chem. 2001;47(11):2055–9. - PubMed

Publication types

MeSH terms