How to understand the association between cystatin C levels and cardiovascular disease: Imbalance, counterbalance, or consequence?

Salgado, João Victor; Souza, Francival Leite de; Salgado, Bernardete Jorge

doi:10.1016/j.jjcc.2013.05.015

Cited by 81 publications

(77 citation statements)

References 47 publications

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“…Therefore, one would expect to observe results/trends comparable with creatinine. However, cystatin C has been associated with atherosclerosis and inflammation, and higher cystatin C levels are observed in hypertensive patients . In addition, cystatin C has been related to diastolic function .…”

Section: Discussionmentioning

confidence: 99%

Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction

Voors

Gori

Liu

et al. 2015

European J of Heart Fail

161

122

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BackgroundIncreases in serum creatinine with renin-angiotensin-aldosterone system (RAAS) inhibitors can lead to unnecessary discontinuation of these agents. The dual-acting angiotensin receptor neprilysin inhibitor LCZ696 improves clinical outcome patients with heart failure with reduced ejection fraction, and pilot data suggest potential benefit in heart failure with preserved ejection fraction (HFpEF). Methods and resultsA total of 301 HFpEF patients were randomly assigned to LCZ696 or valsartan in the PARAMOUNT trial. We studied renal function [creatinine, estimated glomerular filtration rate (eGFR), cystatin C, and urinary albumin to creatinine ratio (UACR)] at baseline, 12 weeks, and after 36 weeks of treatment. Worsening renal function (WRF) was determined as an serum creatinine increase of >0.3 mg/dL and/or >25% between two time-points. Mean eGFR at baseline was 65.4 ± 20.4 mL/min per 1.73 m 2 . The eGFR declined less in the LCZ696 group than in the valsartan group (-1.5 vs. -5.2 mL/min per 1.73 m 2 ; P = 0.002). The incidence of WRF was lower in the LCZ696 group (12%) than in the valsartan group (18%) at any time-point, but this difference was not statistically significant (P = 0.18). Over 36 weeks, the geometric mean of UACR increased in the LCZ696 group (2.4-2.9 mg/mmol), whereas it remained stable in the valsartan group (2.1-2.0 mg/mmol; P for difference between groups = 0.016).

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Section: Discussionmentioning

confidence: 99%

Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction

Voors

Gori

Liu

et al. 2015

European J of Heart Fail

161

122

View full text Add to dashboard Cite

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“…Therefore, we consider that evaluation of renal volume by ultrasound in this study is sufficient for our purpose. Finally, the fact that cystatin C has also been shown to be a biomarker of cardiovascular risk [22]could represent an interfering factor in this renal volume–eGFR cystatin C relationship. Even though, the absence of hypertension among the group of patients studied might reduce the risk of bias.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C estimated glomerular filtration rate to assess renal function in early stages of autosomal dominant polycystic kidney disease

et al. 2017

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Background/AimsHeight-adjusted total kidney volume (htTKV) is the best marker of disease progression in early autosomal dominant polycystic kidney disease (ADPKD) when renal function still remains normal. The usefulness of cystatin-C as a biomarker to assess renal function according to renal volume has not been studied in ADPKD patients.MethodsObservational and cross-sectional study of 62 ADPKD patients. htTKV, creatinine and cystatin-C estimated glomerular filtration rate (eGFR) were determined. Correlations between htTKV and eGFR were studied. A control group was used to determine the association between renal function differences and htTKV.ResultshtTKV significantly correlated with cystatin-C-eGFR (r = -0.384, p = 0.002) but not with creatinine-eGFR (r = -0.225, p = 0.078). With htTKV stratified into tertiles, a significant difference of cystatin-C-eGFR but not in creatinine-eGFR was detected in the third tertile when compared with the first tertile group (110.0±22.2 vs 121.3±7.2; p = 0.023 and 101.8±17.2 vs 106.9±15.1; p = 0.327 respectively). When cystatin-C-eGFR of the controls was used as the reference, htTKV above 605 ml/m identified with a 75% sensitivity and 84.9% specificity those patients with a significant worse kidney function. However, this cut-off value could not be identified using creatinine-eGFR.ConclusionsCystatin-C-eGFR but not creatinine-eGFR correlated with htTKV in ADPKD patients in early stages of the disease. Differences in cystatin-C-eGFR but not in creatinine-eGFR have been identified through htTKV tertiles. A htTKV above 605 ml/m is associated with a worse renal function only if cystatin-C-eGFR is used. Cystatin-C-eGFR should be studied in prospective studies of early stages of ADPKD to determine its usefulness as an early marker of disease progression.

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“…It also seems to be a better indicator of GFR in obese patients because it is less prone to being influenced by body composition [4, 29]. Besides, cystatin C is known to be a sensitive marker of small reductions in renal function and has been shown to detect “preclinical kidney disease,” which is associated with increased risk of CKD progression and cardiovascular death [28, 30]. …”

Section: Discussionmentioning

confidence: 99%

Estimated Visceral Adipose Tissue, but Not Body Mass Index, Is Associated with Reductions in Glomerular Filtration Rate Based on Cystatin C in the Early Stages of Chronic Kidney Disease

França

Santos

Salgado

et al. 2014

International Journal of Nephrology

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Information on the association between obesity and initial phases of chronic kidney disease (CKD) is still limited, principally those regarding the influence of visceral adipose tissue. We investigated whether the visceral adipose tissue is more associated with reductions in glomerular filtration rate (GFR) than total and abdominal obesity in hypertensive individuals with stage 1-2 CKD. A cross-sectional study was implemented which involved 241 hypertensive patients undergoing treatment at a primary health care facility. GFR was estimated using equations based on creatinine and cystatin C levels. Explanatory variables included body mass index (BMI), waist circumference (WC), and estimated visceral adipose tissue (eVAT). The mean age was 59.6 ± 9.2 years old and 75.9% were female. According to BMI, 28.2% of subjects were obese. Prevalence of increased WC and eVAT was 63.9% and 58.5%, respectively. Results from the assessment of GFR by BMI, WC, and eVAT categories showed that only women with increased eVAT (≥150 cm2) had a lower mean GFR by Larsson (P = 0.016), Levey 2 (P = 0.005), and Levey 3 (P = 0.008) equations. The same result was not observed when the MDRD equation was employed. No association was found between BMI, WC, eVAT, and GFR using only serum creatinine. In the early stages of CKD, increased eVAT in hypertensive women was associated with decreased GFR based on cystatin C.

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How to understand the association between cystatin C levels and cardiovascular disease: Imbalance, counterbalance, or consequence?

Cited by 81 publications

References 47 publications

Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction

Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction

Cystatin C estimated glomerular filtration rate to assess renal function in early stages of autosomal dominant polycystic kidney disease

Estimated Visceral Adipose Tissue, but Not Body Mass Index, Is Associated with Reductions in Glomerular Filtration Rate Based on Cystatin C in the Early Stages of Chronic Kidney Disease

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