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Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality.
JAMA 2011; 305(15):1545-52JAMA

Abstract

CONTEXT

A triple-marker approach for chronic kidney disease (CKD) evaluation has not been well studied.

OBJECTIVE

To evaluate whether combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) would improve identification of risks associated with CKD compared with creatinine alone.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study involving 26,643 US adults enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from January 2003 to June 2010. Participants were categorized into 8 groups defined by estimated glomerular filtration rate (GFR) determined by creatinine and by cystatin C of either <60 or ≥60 mL/min/1.73 m(2) and ACR of either <30 or ≥30 mg/g.

MAIN OUTCOME MEASURES

All-cause mortality and incident end-stage renal disease with median follow-up of 4.6 years.

RESULTS

Participants had a mean age of 65 years, 40% were black, and 54% were women. Of 26,643 participants, 1940 died and 177 developed end-stage renal disease. Among participants without CKD defined by creatinine, 24% did not have CKD by either ACR or cystatin C. Compared with those with CKD defined by creatinine alone, the hazard ratio for death in multivariable-adjusted models was 3.3 (95% confidence interval [CI], 2.0-5.6) for participants with CKD defined by creatinine and ACR; 3.2 (95% CI, 2.2-4.7) for those with CKD defined by creatinine and cystatin C, and 5.6 (95% CI, 3.9-8.2) for those with CKD defined by all biomarkers. Among participants without CKD defined by creatinine, 3863 (16%) had CKD detected by ACR or cystatin C. Compared with participants who did not have CKD by any measure, the HRs for mortality were 1.7 (95% CI, 1.4-1.9) for participants with CKD defined by ACR alone, 2.2 (95% CI, 1.9-2.7) for participants with CKD defined by cystatin C alone, and 3.0 (95% CI, 2.4-3.7) for participants with CKD defined by both measures. Risk of incident end-stage renal disease was higher among those with CKD defined by all markers (34.1 per 1000 person-years; 95% CI, 28.7-40.5 vs 0.33 per 1000 person-years; 95% CI, 0.05-2.3) for those with CKD defined by creatinine alone. The second highest end-stage renal disease rate was among persons missed by the creatinine measure but detected by both ACR and cystatin C (rate per 1000 person-years, 6.4; 95% CI, 3.6-11.3). Net reclassification improvement for death was 13.3% (P < .001) and for end-stage renal disease was 6.4% (P < .001) after adding estimated GFR cystatin C in fully adjusted models with estimated GFR creatinine and ACR.

CONCLUSION

Adding cystatin C to the combination of creatinine and ACR measures improved the predictive accuracy for all-cause mortality and end-stage renal disease.

Authors+Show Affiliations

Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA. carmenalicia.peralta@ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21482744

Citation

Peralta, Carmen A., et al. "Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-creatinine Ratio and Association With Progression to End-stage Renal Disease and Mortality." JAMA, vol. 305, no. 15, 2011, pp. 1545-52.
Peralta CA, Shlipak MG, Judd S, et al. Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality. JAMA. 2011;305(15):1545-52.
Peralta, C. A., Shlipak, M. G., Judd, S., Cushman, M., McClellan, W., Zakai, N. A., ... Warnock, D. (2011). Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality. JAMA, 305(15), pp. 1545-52. doi:10.1001/jama.2011.468.
Peralta CA, et al. Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-creatinine Ratio and Association With Progression to End-stage Renal Disease and Mortality. JAMA. 2011 Apr 20;305(15):1545-52. PubMed PMID: 21482744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality. AU - Peralta,Carmen A, AU - Shlipak,Michael G, AU - Judd,Suzanne, AU - Cushman,Mary, AU - McClellan,William, AU - Zakai,Neil A, AU - Safford,Monika M, AU - Zhang,Xiao, AU - Muntner,Paul, AU - Warnock,David, Y1 - 2011/04/11/ PY - 2011/4/13/entrez PY - 2011/4/13/pubmed PY - 2011/4/22/medline SP - 1545 EP - 52 JF - JAMA JO - JAMA VL - 305 IS - 15 N2 - CONTEXT: A triple-marker approach for chronic kidney disease (CKD) evaluation has not been well studied. OBJECTIVE: To evaluate whether combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) would improve identification of risks associated with CKD compared with creatinine alone. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study involving 26,643 US adults enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from January 2003 to June 2010. Participants were categorized into 8 groups defined by estimated glomerular filtration rate (GFR) determined by creatinine and by cystatin C of either <60 or ≥60 mL/min/1.73 m(2) and ACR of either <30 or ≥30 mg/g. MAIN OUTCOME MEASURES: All-cause mortality and incident end-stage renal disease with median follow-up of 4.6 years. RESULTS: Participants had a mean age of 65 years, 40% were black, and 54% were women. Of 26,643 participants, 1940 died and 177 developed end-stage renal disease. Among participants without CKD defined by creatinine, 24% did not have CKD by either ACR or cystatin C. Compared with those with CKD defined by creatinine alone, the hazard ratio for death in multivariable-adjusted models was 3.3 (95% confidence interval [CI], 2.0-5.6) for participants with CKD defined by creatinine and ACR; 3.2 (95% CI, 2.2-4.7) for those with CKD defined by creatinine and cystatin C, and 5.6 (95% CI, 3.9-8.2) for those with CKD defined by all biomarkers. Among participants without CKD defined by creatinine, 3863 (16%) had CKD detected by ACR or cystatin C. Compared with participants who did not have CKD by any measure, the HRs for mortality were 1.7 (95% CI, 1.4-1.9) for participants with CKD defined by ACR alone, 2.2 (95% CI, 1.9-2.7) for participants with CKD defined by cystatin C alone, and 3.0 (95% CI, 2.4-3.7) for participants with CKD defined by both measures. Risk of incident end-stage renal disease was higher among those with CKD defined by all markers (34.1 per 1000 person-years; 95% CI, 28.7-40.5 vs 0.33 per 1000 person-years; 95% CI, 0.05-2.3) for those with CKD defined by creatinine alone. The second highest end-stage renal disease rate was among persons missed by the creatinine measure but detected by both ACR and cystatin C (rate per 1000 person-years, 6.4; 95% CI, 3.6-11.3). Net reclassification improvement for death was 13.3% (P < .001) and for end-stage renal disease was 6.4% (P < .001) after adding estimated GFR cystatin C in fully adjusted models with estimated GFR creatinine and ACR. CONCLUSION: Adding cystatin C to the combination of creatinine and ACR measures improved the predictive accuracy for all-cause mortality and end-stage renal disease. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/21482744/Detection_of_chronic_kidney_disease_with_creatinine_cystatin_C_and_urine_albumin_to_creatinine_ratio_and_association_with_progression_to_end_stage_renal_disease_and_mortality_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2011.468 DB - PRIME DP - Unbound Medicine ER -