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      Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine

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          ABSTRACT

          Background: Cystatin C may add explanatory power for associations with mortality in combination with other filtration markers, possibly indicating pathways other than glomerular filtration rate (GFR). However, this has not been firmly established since interpretation of associations independent of measured GFR (mGFR) is limited by potential multicollinearity between markers of GFR. The primary aim of this study was to assess associations between cystatin C and mortality, independent of mGFR. A secondary aim was to evaluate the utility of combining cystatin C and creatinine to predict mortality risk.

          Methods: Cox regression was used to assess the associations of cystatin C and creatinine with mortality in 1157 individuals referred for assessment of plasma clearance of iohexol.

          Results: Since cystatin C and creatinine are inversely related to mGFR, cystatin C−1 and creatinine−1 were used. After adjustment for mGFR, lower cystatin C−1 (higher cystatin C concentration) and higher creatinine−1 (lower creatinine concentration) were independently associated with increased mortality. When nested models were compared, avoiding the potential influence of multicollinearity, the independence of the associations was supported. Among models combining the markers of GFR, adjusted for demographic factors and comorbidity, cystatin C−1 and creatinine−1 combined explained the largest proportion of variance in associations with mortality risk (R2 = 0.61). Addition of mGFR did not improve the model.

          Conclusions: Our results suggest that both creatinine and cystatin C have independent associations with mortality not explained entirely by mGFR and that mGFR does not offer a more precise mortality risk assessment than these endogenous filtration markers combined.

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          Proportional hazards tests and diagnostics based on weighted residuals

          PATRICIA GRAMBSCH, Terry Therneau (1994)
          Article 0 comments Cited 573 times – based on 0 reviews     Review now
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            Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values.

            A S Levey, J Coresh, T. Greene … (2007)
            We sought to reexpress the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation for estimation of glomerular filtration rate (GFR) using serum creatinine (S(cr)) standardized to reference methods. Serum specimens included creatinine reference materials prepared by the College of American Pathologists (CAP), traceable to primary reference material at the NIST, with assigned values traceable to isotope dilution mass spectrometry (IDMS), a calibration panel prepared by the Cleveland Clinic Research Laboratory (CCRL), and frozen samples from the MDRD Study. Split specimens were measured at the CCRL using the Roche enzymatic and Beckman CX3 kinetic alkaline picrate assays. Roche enzymatic assay results on CAP samples were comparable to IDMS-assigned values. Beckman CX3 assay results in 2004-2005 were significantly higher than but highly correlated with simultaneous Roche enzymatic assay results (r(2) = 0.9994 on 40 CCRL samples) and showed minimal but significant upward drift from Beckman CX3 assay results during the MDRD Study in 1989-1991 (r(2) = 0.9987 in 253 samples). Combining these factors, standardized S(cr) = 0.95 x original MDRD Study S(cr). The reexpressed 4-variable MDRD Study equation for S(cr) (mg/dL) is GFR = 175 x standardized S(cr)(-1.154) x age(-0.203) x 1.212 (if black) x 0.742 (if female), and for S(cr) (micromol/L) is GFR = 30849 x standardized S(cr)(-1.154) x age(-0.203) x 1.212 (if black) x 0.742 (if female) [GFR in mL x min(-1) x (1.73 m(2))(-1)]. When the calibration of S(cr) methods is traceable to the S(cr) reference system, GFR should be estimated using the MDRD Study equation that has been reexpressed for standardized S(cr).
            Article 0 comments Cited 229 times – based on 0 reviews     Review now
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              Cystatin C versus creatinine in determining risk based on kidney function.

              Michael Shlipak, Kunihiro Matsushita, Johan Ärnlöv … (2013)
              Adding the measurement of cystatin C to that of serum creatinine to determine the estimated glomerular filtration rate (eGFR) improves accuracy, but the effect on detection, staging, and risk classification of chronic kidney disease across diverse populations has not been determined. We performed a meta-analysis of 11 general-population studies (with 90,750 participants) and 5 studies of cohorts with chronic kidney disease (2960 participants) for whom standardized measurements of serum creatinine and cystatin C were available. We compared the association of the eGFR, as calculated by the measurement of creatinine or cystatin C alone or in combination with creatinine, with the rates of death (13,202 deaths in 15 cohorts), death from cardiovascular causes (3471 in 12 cohorts), and end-stage renal disease (1654 cases in 7 cohorts) and assessed improvement in reclassification with the use of cystatin C. In the general-population cohorts, the prevalence of an eGFR of less than 60 ml per minute per 1.73 m(2) of body-surface area was higher with the cystatin C-based eGFR than with the creatinine-based eGFR (13.7% vs. 9.7%). Across all eGFR categories, the reclassification of the eGFR to a higher value with the measurement of cystatin C, as compared with creatinine, was associated with a reduced risk of all three study outcomes, and reclassification to a lower eGFR was associated with an increased risk. The net reclassification improvement with the measurement of cystatin C, as compared with creatinine, was 0.23 (95% confidence interval [CI], 0.18 to 0.28) for death and 0.10 (95% CI, 0.00 to 0.21) for end-stage renal disease. Results were generally similar for the five cohorts with chronic kidney disease and when both creatinine and cystatin C were used to calculate the eGFR. The use of cystatin C alone or in combination with creatinine strengthens the association between the eGFR and the risks of death and end-stage renal disease across diverse populations. (Funded by the National Kidney Foundation and others.).
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                Author and article information

                Journal
                Title: Nephrology Dialysis Transplantation
                Publisher: Oxford University Press (OUP)
                ISSN (Print): 0931-0509
                ISSN (Electronic): 1460-2385
                Publication date Created: April 2017
                Publication date Created: April 01 2017
                Publication date Created: March 01 2017
                Publication date Other: April 2017
                Publication date (Print): April 01 2017
                Publication date (Electronic): March 01 2017
                Volume: 32
                Issue: 4
                Pages: 663-670
                Affiliations
                [1 ]School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden
                [2 ]Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
                [3 ]Department of Clinical Chemistry, Laboratory Medicine, University Hospital, Lund, Sweden
                [4 ]Clinical Epidemiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
                [5 ]Department of Epidemiology and Public Health, University College, London, UK
                Article
                DOI: 10.1093/ndt/gfx004
                PMC ID: 6433429
                PubMed ID: 28340079
                SO-VID: 3fdd9e1b-9259-4748-8d46-9f827b4b75ce
                Copyright © © 2017
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