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Combined association of creatinine, albuminuria, and cystatin C with all-cause mortality and cardiovascular and kidney outcomes.
Clin J Am Soc Nephrol 2013; 8(3):434-42CJ

Abstract

BACKGROUND

Estimated GFR by serum creatinine (eGFRcreatinine) is a pivotal measure of kidney function in clinical practice but can be affected by several non-GFR determinants, resulting in misclassification. Combining multiple kidney markers to predict risk is an area of substantial interest.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This study followed 9489 adults from visit 4 (1996-1998) of the Atherosclerosis Risk in Communities Study for a median of 11.2 years, and assessed joint association of eGFRcreatinine, eGFRcystatin, and urinary albumin/creatinine ratio (ACR) with mortality, coronary heart disease, heart failure, AKI, and ESRD using Cox proportional hazards models. The predictive ability of ACR and eGFRcystatin beyond eGFRcreatinine was also investigated.

RESULTS

Lower eGFRcreatinine and eGFRcystatin as well as elevated ACR were independently associated with risk for all outcomes. eGFRcreatinine <60 was not associated with risk of mortality, coronary heart disease, or heart failure if eGFRcystatin ≥60 with ACR <30 mg/g compared with those with all three markers above CKD cutoffs (i.e., eGFRcystatin ≥60, eGFRcreatinine ≥60, and ACR<30), whereas risk association with kidney outcomes remained: Hazard ratio (95% confidence interval), 0.96 (0.66, 1.39) for mortality, 0.85 (0.55, 1.31) for coronary heart disease, 0.99 (0.60, 1.63) for heart failure, 1.61 (0.92, 2.82) for AKI, and 3.53 (1.06, 11.68) for ESRD. Adding ACR to the fully adjusted model with eGFRcreatinine or adding eGFRcystatin to both eGFRcreatinine and ACR improved risk classification for all outcomes (P ≤ 0.01).

CONCLUSIONS

eGFRcystatin can be a useful confirmatory marker in those with eGFRcreatinine <60 and whose ACR is <30 mg/g. This approach improves risk classification, and provides reassurance to a large group of individuals with eGFRcreatinine <60.

Authors+Show Affiliations

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. salmanwaheed@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23258794

Citation

Waheed, Salman, et al. "Combined Association of Creatinine, Albuminuria, and Cystatin C With All-cause Mortality and Cardiovascular and Kidney Outcomes." Clinical Journal of the American Society of Nephrology : CJASN, vol. 8, no. 3, 2013, pp. 434-42.
Waheed S, Matsushita K, Astor BC, et al. Combined association of creatinine, albuminuria, and cystatin C with all-cause mortality and cardiovascular and kidney outcomes. Clin J Am Soc Nephrol. 2013;8(3):434-42.
Waheed, S., Matsushita, K., Astor, B. C., Hoogeveen, R. C., Ballantyne, C., & Coresh, J. (2013). Combined association of creatinine, albuminuria, and cystatin C with all-cause mortality and cardiovascular and kidney outcomes. Clinical Journal of the American Society of Nephrology : CJASN, 8(3), pp. 434-42. doi:10.2215/CJN.04960512.
Waheed S, et al. Combined Association of Creatinine, Albuminuria, and Cystatin C With All-cause Mortality and Cardiovascular and Kidney Outcomes. Clin J Am Soc Nephrol. 2013;8(3):434-42. PubMed PMID: 23258794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined association of creatinine, albuminuria, and cystatin C with all-cause mortality and cardiovascular and kidney outcomes. AU - Waheed,Salman, AU - Matsushita,Kunihiro, AU - Astor,Brad C, AU - Hoogeveen,Ron C, AU - Ballantyne,Christie, AU - Coresh,Josef, Y1 - 2012/12/20/ PY - 2012/12/22/entrez PY - 2012/12/22/pubmed PY - 2013/8/27/medline SP - 434 EP - 42 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 8 IS - 3 N2 - BACKGROUND: Estimated GFR by serum creatinine (eGFRcreatinine) is a pivotal measure of kidney function in clinical practice but can be affected by several non-GFR determinants, resulting in misclassification. Combining multiple kidney markers to predict risk is an area of substantial interest. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study followed 9489 adults from visit 4 (1996-1998) of the Atherosclerosis Risk in Communities Study for a median of 11.2 years, and assessed joint association of eGFRcreatinine, eGFRcystatin, and urinary albumin/creatinine ratio (ACR) with mortality, coronary heart disease, heart failure, AKI, and ESRD using Cox proportional hazards models. The predictive ability of ACR and eGFRcystatin beyond eGFRcreatinine was also investigated. RESULTS: Lower eGFRcreatinine and eGFRcystatin as well as elevated ACR were independently associated with risk for all outcomes. eGFRcreatinine <60 was not associated with risk of mortality, coronary heart disease, or heart failure if eGFRcystatin ≥60 with ACR <30 mg/g compared with those with all three markers above CKD cutoffs (i.e., eGFRcystatin ≥60, eGFRcreatinine ≥60, and ACR<30), whereas risk association with kidney outcomes remained: Hazard ratio (95% confidence interval), 0.96 (0.66, 1.39) for mortality, 0.85 (0.55, 1.31) for coronary heart disease, 0.99 (0.60, 1.63) for heart failure, 1.61 (0.92, 2.82) for AKI, and 3.53 (1.06, 11.68) for ESRD. Adding ACR to the fully adjusted model with eGFRcreatinine or adding eGFRcystatin to both eGFRcreatinine and ACR improved risk classification for all outcomes (P ≤ 0.01). CONCLUSIONS: eGFRcystatin can be a useful confirmatory marker in those with eGFRcreatinine <60 and whose ACR is <30 mg/g. This approach improves risk classification, and provides reassurance to a large group of individuals with eGFRcreatinine <60. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/23258794/Combined_association_of_creatinine_albuminuria_and_cystatin_C_with_all_cause_mortality_and_cardiovascular_and_kidney_outcomes_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=23258794 DB - PRIME DP - Unbound Medicine ER -