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. 2011 Jan;22(1):147-55.
doi: 10.1681/ASN.2010050483. Epub 2010 Dec 16.

Cystatin C identifies chronic kidney disease patients at higher risk for complications

Carmen A Peralta  1 , Ronit Katz, Mark J Sarnak, Joachim Ix, Linda F Fried, Ian De Boer, Walter Palmas, David Siscovick, Andrew S Levey, Michael G Shlipak
Affiliations

Cystatin C identifies chronic kidney disease patients at higher risk for complications

Carmen A Peralta et al. J Am Soc Nephrol. 2011 Jan.

Abstract

Although cystatin C is a stronger predictor of clinical outcomes associated with CKD than creatinine, the clinical role for cystatin C is unclear. We included 11,909 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS) and assessed risks for death, cardiovascular events, heart failure, and ESRD among persons categorized into mutually exclusive groups on the basis of the biomarkers that supported a diagnosis of CKD (eGFR <60 ml/min per 1.73 m(2)): creatinine only, cystatin C only, both, or neither. We used CKD-EPI equations to estimate GFR from these biomarkers. In MESA, 9% had CKD by the creatinine-based equation only, 2% had CKD by the cystatin C-based equation only, and 4% had CKD by both equations; in CHS, these percentages were 12, 4, and 13%, respectively. Compared with those without CKD, the adjusted hazard ratios (HR) for mortality in MESA were: 0.80 (95% CI 0.50 to 1.26) for CKD by creatinine only; 3.23 (95% CI 1.84 to 5.67) for CKD by cystatin C only; and 1.93 (95% CI 1.27 to 2.92) for CKD by both; in CHS, the adjusted HR were 1.09 (95% CI 0.98 to 1.21), 1.78 (95% CI 1.53 to 2.08), and 1.74 (95% CI 1.58 to 1.93), respectively. The pattern was similar for cardiovascular disease (CVD), heart failure, and kidney failure outcomes. In conclusion, among adults diagnosed with CKD using the creatinine-based CKD-EPI equation, the adverse prognosis is limited to the subset who also have CKD according to the cystatin C-based equation. Cystatin C may have a role in identifying persons with CKD who have the highest risk for complications.

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Figures

Figure 1.
Figure 1.
Age-adjusted rate of death was highest for those with decreased GFRcys only and decreased GFR both, but not among those with decreased GFRcreat only.
Figure 2.
Figure 2.
(A) The prevalence of eGFRcr ≥60 ml/min per 1.73 m2 and the proportion missed by creatinine but detected by cystatin C varies by age. (B) The overall prevalence of eGFR <60 ml/min per 1.73 m2 by creatinine and proportion confirmed by cystatin C varies by age.
Figure 3.
Figure 3.
CART tree for detection of eGFRcys <60 ml/min per 1.73 m2 by age, gender, and race in MESA and CHS.
See this image and copyright information in PMC

Comment in

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