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Comparative Study
. 2011 Jun;57(6):832-40.
doi: 10.1053/j.ajkd.2010.11.021. Epub 2011 Feb 5.

Cystatin C and albuminuria as risk factors for development of CKD stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA)

Shani Shastri  1 , Ronit Katz, Michael G Shlipak, Bryan Kestenbaum, Carmen A Peralta, Holly Kramer, David R Jacobs Jr, Ian H de Boer, Mary Cushman, David Siscovick, Mark J Sarnak
Affiliations
Comparative Study

Cystatin C and albuminuria as risk factors for development of CKD stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA)

Shani Shastri et al. Am J Kidney Dis. 2011 Jun.

Abstract

Background: The growing burden and morbidity of chronic kidney disease (CKD) warrant effective strategies for identifying those at increased risk. We examined the association of cystatin C level and albuminuria with the development of CKD stage 3.

Study design: Prospective observational study.

Setting & participants: 5,422 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2).

Predictor: Participants were categorized into 4 mutually exclusive groups: the presence or absence of microalbuminuria (albumin-creatinine ratio >17 and >25 μg/mg in men and women, respectively) in those with or without cystatin C level ≥1.0 mg/L.

Outcomes & measurements: Incident CKD stage 3 was defined as eGFR <60 mL/min/1.73 m(2) at the third or fourth visit and an annual decrease >1 mL/min/1.73 m(2). Poisson regression was used to evaluate incident rate ratios in unadjusted and adjusted analyses that include baseline eGFR.

Results: Mean age was 61 years, 49% were men, 38% were white, 11% had diabetes, 13.7% had cystatin C level ≥1 mg/L, 8.4% had microalbuminuria, and 2.7% had cystatin C level ≥1 mg/L with microalbuminuria. 554 (10%) participants developed CKD stage 3 during a median follow-up of 4.7 years, and adjusted incidence rate ratios were 1.57 (95% CI, 1.19-2.07), 1.37 (95% CI, 1.13-1.66), and 2.12 (95% CI, 1.61-2.80) in those with microalbuminuria, cystatin C level ≥1 mg/L, and both, respectively, compared with those with neither.

Limitations: Relatively short follow-up and absence of measured GFR.

Conclusions: Cystatin C level and microalbuminuria are independent risk factors for incident CKD stage 3 and could be useful as screening tools to identify those at increased risk.

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Conflict of interest statement

N section : Because a quorum could not be reached after those editors with potential conflicts recused themselves from consideration of this manuscript, the peer-review and decision-making processes were handled entirely by an Associate Editor (Mark M. Mitsnefes, MD, Cincinnati Children's Hospital Medical Center) who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.

Figures

Figure 1
Figure 1
Cystatin C spline evaluating the shape of the relationship with incident rate ratios of chronic kidney disease stage 3 after adjusting for age, gender, and race and excluding the top and bottom 2.5%. Conversion factor for units: Cystatin C in mg/L to nmol/L, ×74.9
Figure 2
Figure 2
Annual unadjusted rate of incident chronic kidney disease stage 3 by quartiles of cystatin C and presence of microalbuminuria. Conversion factor for units: Cystatin C in mg/L to nmol/L, ×74.9
See this image and copyright information in PMC

Comment in

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