Discrepancies between Cystatin C-Based and Creatinine-Based eGFR.
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
received:
06
12
2022
accepted:
09
06
2023
pmc-release:
01
09
2024
medline:
11
9
2023
pubmed:
20
6
2023
entrez:
20
6
2023
Statut:
ppublish
Résumé
Recent guidance suggests clinicians increase use of cystatin C for the estimation of GFR. Discrepant levels of creatinine- versus cystatin C-based eGFR (eGFRcr versus eGFRcys) can occur and might signify inaccurate estimation of GFR using creatinine alone. This study sought to enhance the knowledge of the risk factors and clinical implications of having a large eGFR discrepancy. Participants in the Atherosclerosis Risk in Communities Study, a prospective cohort study of US adults, were followed over 25 years. eGFR discrepancy was measured at five clinical visits and defined as eGFRcys either 30% lower or higher than eGFRcr, the current clinical standard of care. The associations between eGFR discrepancies and kidney-related laboratory parameters were assessed using linear and logistic regression and long-term adverse outcomes, including kidney failure, AKI, heart failure, and death, using Cox proportional hazards models. Among 13,197 individuals (mean age 57 [SD 6] years, 56% women, 25% Black race), 7% had eGFRcys 30% lower than eGFRcr at visit 2 (1990-1992), and this proportion increased over time to 23% by visit 6 (2016-2017). By contrast, the percent with eGFRcys 30% higher than eGFRcr was relatively stable (3%-1%). Independent risk factors for having eGFRcys 30% lower than eGFRcr included older age, female sex, non-Black race, higher eGFRcr, higher body mass index, weight loss, and current smoking. Those with eGFRcys 30% lower than eGFRcr had more anemia and higher uric acid, fibroblast growth factor 23, and phosphate levels as well as higher risk of subsequent mortality, kidney failure, AKI, and heart failure compared with those with similar eGFRcr and eGFRcys values. Having eGFRcys lower than eGFRcr was associated with worse kidney-related laboratory derangements and a higher risk of adverse health outcomes. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_09_08_CJN0000000000000217.mp3.
Sections du résumé
BACKGROUND
Recent guidance suggests clinicians increase use of cystatin C for the estimation of GFR. Discrepant levels of creatinine- versus cystatin C-based eGFR (eGFRcr versus eGFRcys) can occur and might signify inaccurate estimation of GFR using creatinine alone. This study sought to enhance the knowledge of the risk factors and clinical implications of having a large eGFR discrepancy.
METHODS
Participants in the Atherosclerosis Risk in Communities Study, a prospective cohort study of US adults, were followed over 25 years. eGFR discrepancy was measured at five clinical visits and defined as eGFRcys either 30% lower or higher than eGFRcr, the current clinical standard of care. The associations between eGFR discrepancies and kidney-related laboratory parameters were assessed using linear and logistic regression and long-term adverse outcomes, including kidney failure, AKI, heart failure, and death, using Cox proportional hazards models.
RESULTS
Among 13,197 individuals (mean age 57 [SD 6] years, 56% women, 25% Black race), 7% had eGFRcys 30% lower than eGFRcr at visit 2 (1990-1992), and this proportion increased over time to 23% by visit 6 (2016-2017). By contrast, the percent with eGFRcys 30% higher than eGFRcr was relatively stable (3%-1%). Independent risk factors for having eGFRcys 30% lower than eGFRcr included older age, female sex, non-Black race, higher eGFRcr, higher body mass index, weight loss, and current smoking. Those with eGFRcys 30% lower than eGFRcr had more anemia and higher uric acid, fibroblast growth factor 23, and phosphate levels as well as higher risk of subsequent mortality, kidney failure, AKI, and heart failure compared with those with similar eGFRcr and eGFRcys values.
CONCLUSIONS
Having eGFRcys lower than eGFRcr was associated with worse kidney-related laboratory derangements and a higher risk of adverse health outcomes.
PODCAST
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_09_08_CJN0000000000000217.mp3.
Identifiants
pubmed: 37339177
doi: 10.2215/CJN.0000000000000217
pii: 01277230-202309000-00009
pmc: PMC10564370
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Cystatin C
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1143-1152Subventions
Organisme : NIDDK NIH HHS
ID : T32 DK007732
Pays : United States
Organisme : NHLBI NIH HHS
ID : K24 HL155861
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK115534
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK124399
Pays : United States
Organisme : NHLBI NIH HHS
ID : 75N92022D00001
Pays : United States
Organisme : NHLBI NIH HHS
ID : 75N92022D00002
Pays : United States
Organisme : NHLBI NIH HHS
ID : 75N92022D00003
Pays : United States
Organisme : NHLBI NIH HHS
ID : 75N92022D00004
Pays : United States
Organisme : NHLBI NIH HHS
ID : 75N92022D00005
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK089174
Pays : United States
Informations de copyright
Copyright © 2023 by the American Society of Nephrology.
Références
Am J Kidney Dis. 2020 Dec;76(6):765-774
pubmed: 32682697
Clin Chem. 2002 May;48(5):699-707
pubmed: 11978596
N Engl J Med. 2021 Nov 4;385(19):1737-1749
pubmed: 34554658
N Engl J Med. 2021 Nov 4;385(19):1750-1760
pubmed: 34554660
Atherosclerosis. 2021 Oct;335:53-61
pubmed: 34571286
Scand J Clin Lab Invest. 2015 Jul;75(4):333-40
pubmed: 25919022
JAMA Netw Open. 2022 Feb 1;5(2):e2148940
pubmed: 35175342
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Am J Kidney Dis. 2022 Dec;80(6):762-772.e1
pubmed: 35817274
Kidney Int. 2013 Sep;84(3):622-3
pubmed: 23989362
JAMA Intern Med. 2020 May 1;180(5):793-795
pubmed: 32176270
N Engl J Med. 2013 Sep 5;369(10):932-43
pubmed: 24004120
Kidney Int. 2021 Jan;99(1):34-47
pubmed: 33127436
Am J Kidney Dis. 2016 Feb;67(2):342-4
pubmed: 26530874
Am J Kidney Dis. 2020 Dec;76(6):896-898
pubmed: 32682698
Am J Kidney Dis. 2020 Feb;75(2):235-244
pubmed: 31668375
J Am Soc Nephrol. 2021 Dec 1;32(12):2994-3015
pubmed: 34556489
Am J Kidney Dis. 2017 Feb;69(2):321-323
pubmed: 27876172
JAMA. 2022 Sep 6;328(9):883-884
pubmed: 35939309
Am J Kidney Dis. 2021 Nov;78(5):736-749
pubmed: 34518032
N Engl J Med. 2021 Feb 4;384(5):396-399
pubmed: 33406354
Kidney Int Suppl (2011). 2017 Jul;7(1):1-59
pubmed: 30675420
Nat Med. 2019 Nov;25(11):1753-1760
pubmed: 31700174
Kidney Int. 1990 Jul;38(1):167-84
pubmed: 2200925
BMC Nephrol. 2017 Dec 4;18(1):350
pubmed: 29202804
N Engl J Med. 2012 Jul 5;367(1):20-9
pubmed: 22762315
Ann Rheum Dis. 2017 Jan;76(1):29-42
pubmed: 27457514
N Engl J Med. 2006 Jun 8;354(23):2473-83
pubmed: 16760447
J Intern Med. 2023 Mar;293(3):293-308
pubmed: 36385445
J Am Coll Cardiol. 2021 Jun 15;77(23):2939-2959
pubmed: 34112321
Kidney Int. 1985 Nov;28(5):830-8
pubmed: 2418254
Am J Kidney Dis. 2002 Aug;40(2):221-6
pubmed: 12148093
Kidney Int. 2011 Jun;79(12):1370-8
pubmed: 21389978
Nat Rev Nephrol. 2020 Jan;16(1):51-64
pubmed: 31527790
Ann Intern Med. 2012 Jun 5;156(11):785-95
pubmed: 22312131
JAMA. 2019 Jul 9;322(2):113-114
pubmed: 31169890
Med Clin North Am. 2005 May;89(3):457-73
pubmed: 15755462