Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years’ Korean Genome and Epidemiology Study (KoGES)

Abstract

Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m2, a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m2 were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m2 on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m2. The incidence of the development of eGFR <60 mL/min/1.73 m2 was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m2 (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29–6.74 in females; HR, 12.77; 95% CI, 7.69–21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m2 (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development.

A soft voting ensemble classifier for early prediction and diagnosis of occurrences of major adverse cardiovascular events for STEMI and NSTEMI during 2-year follow-up in patients with acute coronary syndrome

“…The concentration of serum creatinine is increased by renal dysfunction. The abnormal range for male is >1.2 mg / dl and >1.0 mg / dl for females [ 41 ].…”

Causal Pathways from Body Components and Regional Fat to Extensive Metabolic Phenotypes: A Mendelian Randomization Study

“…Besides this, we also found that BFFM increases Crea levels and CKD risk. The serum Crea level was a surrogate of muscle mass (44) and has been used to assess kidney function and also as a predictor of CKD (45). However, the positive effect of BFFM on CKD may be due to higher BFFM leading to an increased Crea level, thus causing underestimated kidney function.…”

Predictores de la función renal en una cohorte de adultos mexicanos

“…19 Según las guías de la organización Kidney Disease: Improving Global Outcomes (KDIGO) para la evaluación de la función renal en adultos, también se incluyó la CrS, 5 que en conjunto con el AU son considerados marcadores de la función renal. [8][9][10] Se definió como disminuida una TFGE <90 ml/min/1.73 m 2 . La CrS (mg/dL) y el AU (mg/dL) fueron determinados mediante el Sistema SYNCHRON-CX en las muestras séricas colectadas previo ayuno de ≥8 horas.…”

“…5,7 La creatinina sérica (CrS) es un metabolito del fosfato de creatina y el marcador endógeno de filtración renal más empleado. 8,9 El ácido úrico (AU) es un antioxidante plasmático metabolito de las purinas utilizado como marcador de función renal, también es considerado factor de riesgo independiente en el desarrollo y progresión de la ERC. 10,11 Estos marcadores bajo costo medidos comúnmente en la práctica clínica pueden ser de utilidad para identificar alteraciones de la función renal en población adulta en riesgo de desarrollar ERC.…”