Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate, Vascular Disease, and Mortality in Persons With Diabetes in the U.S.

Abstract

OBJECTIVESerum cystatin C is an alternative to serum creatinine for estimating glomerular filtration rate (GFR), since cystatin C is less influenced by age and muscle mass. Among persons with diabetes, we compared the performance of GFR estimated using cystatin C (eGFRcys) with that using creatinine (eGFRcr) for the identification of reduced kidney function and its association with diabetes complications.RESEARCH DESIGN AND METHODSWe analyzed data from adult participants from the 1999–2002 National Health and Nutrition Examination Survey with available cystatin C (N = 4,457). Kidney function was dichotomized as preserved (eGFR ≥60 mL/min/1.73 m2) or reduced (eGFR <60 mL/min/1.73 m2) using the 2012 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C and the 2009 CKD-EPI creatinine equations.RESULTSAmong 778 persons with diabetes, the prevalence of reduced kidney function was 16.5% using eGFRcr and 22.0% using eGFRcys. More persons with diabetes were reclassified from preserved kidney function by eGFRcr to reduced kidney function by eGFRcys than persons without diabetes (odds ratio 3.1 [95% CI 1.9–4.9], P < 0.001). The associations between lower eGFR and higher prevalence of albuminuria, retinopathy, peripheral arterial disease, and coronary artery disease were robust regardless of filtration marker. Similarly, the risk of all-cause mortality increased with lower eGFRcr and eGFRcys. Only lower eGFRcys was significantly associated with cardiovascular mortality.CONCLUSIONSMore persons with diabetes had reduced kidney function by eGFRcys than by eGFRcr, and lower eGFRcys was strongly associated with diabetes complications. Whether eGFRcys is superior to eGFRcr in approximating true kidney function in a diabetic population requires additional study.

Comparison of cystatin C- and creatinine-based estimated glomerular filtration rate to predict coronary heart disease risk in Japanese patients with obesity and diabetes

“…Additionally, there was a report revealing that eGFRcys and cystatin C-based eGFR with creatinine (eGFRCr-CysC) had a stronger association with CKD risk factors than did the gold-standard measured GFR (mGFR) and eGFRcre [17]. Furthermore, another study reported that, in subjects with diabetes, the prevalence of reduced kidney function by eGFRcys was higher than that using eGFRcre, and a lower eGFRcys was strongly associated with diabetic complications [18]. These studies are consistent with our results showing that S-CysC and eGFRcys were more strongly correlated with the 10-year CHD risk and CAVI than serum creatinine and eGFRcre.…”

Cystatin C Is a More Reliable Biomarker for Determining eGFR to Support Drug Development Studies

“…Several creatinine‐based eGFR equations overestimated GFR, potentially leading to false negatives or discrepant results. In a large National Health and Nutrition Examination Survey study, discordance between the classification of reduced kidney function by creatinine‐ or cystatin C–based CKD‐EPI eGFR was approximately 12% in persons with diabetes and 5% in persons without diabetes . Accurately monitoring early decreases in GFR is especially important in patients with diabetes because of their increased risk for kidney damage.…”

Predicting survival of older community‐dwelling individuals according to five estimated glomerular filtration rate equations: The InChianti study

“…1 Recognizing CKD prevents drug overdosage and adverse reactions, as well as contributing to predicting survival, especially in selected categories. 2 Indeed, dramatic differences in survival according to different levels of estimated glomerular filtration rate (eGFR) have been observed in patients having heart failure, 3 coronary artery disease 4 or diabetes 5 as the main disease. In the same way, eGFR was found to accurately predict mortality in older people.…”