Cystatin C and Long-Term Mortality Among Subjects With Normal Creatinine-Based Estimated Glomerular Filtration Rates

Wu, Cho Kai; Lin, Jou‐Wei; Caffrey, James L.; Chang, Man‐Huei; Hwang, Juey‐Jen; Lin, Yu‐Sheng

doi:10.1016/j.jacc.2010.04.069

Cited by 81 publications

(72 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…43 Serum cystatin C was a strong and independent predictor of mortality also in patients with normal to moderately impaired renal function. 42,44,45 In these studies, GFR was estimated by using less accurate CockcroftGault or MDRD Study equations. It is interesting that after multivariate analysis in the study by Shlipak et al in the elderly, the first and the second quintiles of serum cystatin C had similar long-term mortality rate, the third and the fourth quintiles were associated with moderately increased risk, and fifth quintile was clearly associated with increased risk of long-term mortality.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

2013

View full text Add to dashboard Cite

Renal dysfunction is associated with mortality in patients after ischemic stroke. Cystatin C is a potentially superior marker of renal function compared to creatinine and estimated glomerular filtration rate (GFR). In our observational cohort study, 390 Caucasian patients suffered from acute ischemic stroke (mean age 70.9 years; 183 women and 207 men) were included and prospectively followed up to maximal 56 months. Serum creatinine and cystatin C were measured at admission to the hospital; GFR was estimated according to CKD-EPI creatinine and CKD-EPI creatinine/cystatin equations. According to values of serum creatinine, estimated GFR and serum cystatin C patients were divided into quintiles. In the follow-up period, 191 (49%) patients died. For serum cystatin C and estimated GFR based on creatinine and cystatin C, the mortality and the hazard ratios for long-term mortality increased from the first to the fifth quintile nearly linearly. The associations of serum creatinine and estimated GFR categories based on creatinine with long-term mortality were J-shaped. As compared with lowest quintile of serum cystatin C, the fifth quintile was associated with long-term mortality significantly also after multivariate adjustment (age, gender, initial stroke severity, known risk factors for stroke mortality). In contrast, in adjusted analysis serum creatinine and estimated GFR (CKD-EPI creatinine and CKD-EPI creatinine/cystatin) were not associated with long-term mortality. In summary, serum cystatin C was independently and better associated with the risk of long-term mortality in patients suffering from ischemic stroke than were creatinine and estimated GFR using both CKD-EPI equations.

show abstract

Section: Discussionmentioning

confidence: 99%

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

2013

View full text Add to dashboard Cite

show abstract

“…[25][26][27] Moreover, increased cystatin C was associated with all-cause, cardiovascular, and even non-cardiovascular mortality in a population-based cohort of subjects with normal kidney function. 28 However, whether cystatin C merely reflects the association of mildly impaired kidney function with increased risk of cardiovascular disease, or is an independent risk factor involved in the pathogenesis of atherosclerosis, has not been fully elucidated. Cystatin C is an endogenous inhibitor of potentially destructive proteases such as cathepsins, and is severely reduced and associated with abundant levels of cathepsins in atherosclerotic lesions.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function - the Tromso study

Brodin¹,

Brækkan²,

Vik³

et al. 2012

Haematologica

View full text Add to dashboard Cite

BackgroundPrevious studies have shown an association between impaired kidney function, assessed by cystatin C-based estimated glomerular filtration rate, and venous thromboembolism. The aim of this study was to investigate whether serum cystatin C was associated with a risk of venous thromboembolism among subjects with normal kidney function in a prospective population-based study. Design and MethodsCystatin C was measured in serum from 3251 men and women with normal kidney function, aged 25-84 years, who participated in the Tromsø study in 1994-1995. Normal kidney function was defined as a creatinine-based estimated glomerular filtration rate greater than 90 mL/min/1.73 m 2 and absence of microalbuminuria. Incident venous thromboembolism was registered from the date of inclusion through to the end of follow-up, September 1, 2007. Cox-regression models were used to calculate hazard ratios with 95% confidence intervals for venous thromboembolism. ResultsThere were 83 incident venous thromboembolic events, of which 53 (63.9 %) were provoked, during a median of 12.3 years of follow-up. A one standard deviation (0.11 mg/L) increase in serum cystatin C levels was associated with a 43% (hazard ratio 1.43; 95% confidence interval 1.17-1.72) increased risk of total venous thromboembolism. Subjects with cystatin C levels in the top quartile (≥0.87 mg/L) had a 2.5-fold (hazard ratio 2.51; 95% confidence interval 1.27-4.96) increased risk of venous thromboembolism compared to those with levels in the bottom quartile (≤0.72 mg/L) in adjusted analysis. The risk estimates were even higher for provoked venous thromboembolism (hazard ratio 3.11; 95% confidence interval 1.23-7.86). ConclusionsSerum cystatin C levels were associated with the risk of venous thromboembolism in subjects with normal kidney function. Our findings suggest that elevated serum cystatin C levels may promote venous thrombosis beyond reflecting impaired kidney function.Key words: cystatin C, venous thromboembolism, VTE, risk. 2012;97(7):1008-1013. doi:10.3324/haematol.2011 Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function -the Tromsø study Citation: Brodin EE, Braekkan SK, Vik A, Brox J, and Hansen J-B. Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function -the Tromsø study. Haematologica ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n

show abstract

“…Cystatin C (CysC) production and hence, blood levels are less affected by sex and muscle mass (11,12). CysC levels also seem to be associated with CV factors and outcomes (13)(14)(15)(16)(17), which are, to some extent, independent of GFR (9,(18)(19)(20)(21)(22)(23). The association of Cr-and CysC-based eGFR with CV risk factors independent of mGFR in the transplant population has not been well elucidated.…”

Section: Introductionmentioning

confidence: 99%

Creatinine–Based and Cystatin C–Based GFR Estimating Equations and Their Non-GFR Determinants in Kidney Transplant Recipients

Keddis

Amer

Voskoboev

et al. 2016

CJASN

View full text Add to dashboard Cite

Background and objectives eGFR equations have been evaluated in kidney transplant recipients with variable performance. We assessed the performance of the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors.Design, setting, participants, & measurements A cross-sectional cohort of 1139 kidney transplant recipients .1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30% of measured GFR) were assessed. Interaction of each cardiovascular risk factor with eGFR relative to measured GFR was determined.Results Median measured GFR was 55.0 ml/min per 1.73 m 2 . eGFR creatinine overestimated measured GFR by 3.1% (percentage of estimates within 30% of measured GFR of 80.4%), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2% (percentage of estimates within 30% of measured GFR of 80.4%). eGFR cystatin C underestimated measured GFR by 213.7% (percentage of estimates within 30% of measured GFR of 77.1%), and eGFR creatinine-cystatin C underestimated measured GFR by 28.1% (percentage of estimates within 30% of measured GFR of 86.5%). Lower measured GFR associated with older age, women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification of Diet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C.Conclusions Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.

show abstract

Cystatin C and Long-Term Mortality Among Subjects With Normal Creatinine-Based Estimated Glomerular Filtration Rates

Abstract: Serum Cys-C is prognostic of long-term mortality in the subjects with relatively normal renal function, independent of MDRD eGFR and albuminuria.

Cited by 81 publications

References 32 publications

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function - the Tromso study

Creatinine–Based and Cystatin C–Based GFR Estimating Equations and Their Non-GFR Determinants in Kidney Transplant Recipients

Contact Info

Product

Resources

About