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Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease.
Tuesday,2012-11-06 12:07 America/Los_Angeles — eenright
| Title | Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. |
| Publication Type | Journal Article |
| Year of Publication | 2006 |
| Authors | Shlipak, MG, Katz, R, Sarnak, MJ, Fried, LF, Newman, AB, Stehman-Breen, C, Seliger, SL, Kestenbaum, B, Psaty, B, Tracy, RP, Siscovick, DS |
| Journal | Ann Intern Med |
| Volume | 145 |
| Issue | 4 |
| Pagination | 237-46 |
| Date Published | 2006 Aug 15 |
| ISSN | 1539-3704 |
| Keywords | Aged, Biomarkers, Cardiovascular Diseases, Creatinine, Cystatin C, Cystatins, Glomerular Filtration Rate, Humans, Kidney, Longitudinal Studies, Prognosis, Proportional Hazards Models, Renal Insufficiency, Chronic, Risk Factors |
| Abstract | <p><b>BACKGROUND: </b>Cystatin C is an alternative measure of kidney function that may have prognostic importance among elderly persons who do not meet standard criteria for chronic kidney disease (estimated glomerular filtration rate [GFR] > or =60 mL/min per 1.73 m2).</p><p><b>OBJECTIVE: </b>To evaluate cystatin C as a prognostic biomarker for death, cardiovascular disease, and incident chronic kidney disease among elderly persons without chronic kidney disease.</p><p><b>DESIGN: </b>Cohort study.</p><p><b>SETTING: </b>The Cardiovascular Health Study, a population-based cohort recruited from 4 communities in the United States.</p><p><b>PARTICIPANTS: </b>4663 elderly persons.</p><p><b>MEASUREMENTS: </b>Measures of kidney function were creatinine-based estimated GFR by using the Modification of Diet in Renal Disease equation and cystatin C concentration. Outcomes were death, cardiovascular death, noncardiovascular death, heart failure, stroke, myocardial infarction, and incident chronic kidney disease during follow-up (median, 9.3 years).</p><p><b>RESULTS: </b>At baseline, 78% of participants did not have chronic kidney disease (estimated GFR > or =60 mL/min per 1.73 m2) and mean cystatin C concentration, creatinine concentration, and estimated GFR were 1.0 mg/L, 79.6 micromol/L (0.9 mg/dL), and 83 mL/min per 1.73 m2, respectively. Cystatin C concentrations (per SD, 0.18 mg/L) had strong associations with death (hazard ratio, 1.33 [95% CI, 1.25 to 1.40]), cardiovascular death (hazard ratio, 1.42 [CI, 1.30 to 1.54]), noncardiovascular death (hazard ratio, 1.26 [CI, 1.17 to 1.36]), incident heart failure (hazard ratio, 1.28 [CI, 1.17 to 1.40]), stroke (hazard ratio, 1.22 [CI, 1.08 to 1.38]), and myocardial infarction (hazard ratio, 1.20 [CI, 1.06 to 1.36]) among these participants. Serum creatinine concentrations had much weaker associations with each outcome and only predicted cardiovascular death. Participants without chronic kidney disease who had elevated cystatin C concentrations (> or =1.0 mg/L) had a 4-fold risk for progressing to chronic kidney disease after 4 years of follow-up compared with those with cystatin C concentrations less than 1.0 mg/L.</p><p><b>LIMITATIONS: </b>Because this study did not directly measure GFR or albuminuria, the extent to which cystatin C may be influenced by nonrenal factors was not determined and participants with albuminuria might have been misclassified as having no kidney disease.</p><p><b>CONCLUSIONS: </b>Among elderly persons without chronic kidney disease, cystatin C is a prognostic biomarker of risk for death, cardiovascular disease, and chronic kidney disease. In this setting, cystatin C seems to identify a "preclinical" state of kidney dysfunction that is not detected with serum creatinine or estimated GFR.</p> |
| DOI | 10.7326/0003-4819-145-4-200608150-00003 |
| Alternate Journal | Ann Intern Med |
| PubMed ID | 16908914 |
| Grant List | N01-HC-15103 / HC / NHLBI NIH HHS / United States N01-HC-35129 / HC / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States R01 AG027002 / AG / NIA NIH HHS / United States R01 DK066488 / DK / NIDDK NIH HHS / United States R01 HL073208-01 / HL / NHLBI NIH HHS / United States |