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Cystatin C and measures of physical function in elderly adults: the Health, Aging, and Body Composition (HABC) Study
Michelle C Odden1, Glenn M Chertow, Linda F Fried
1General Internal Medicine Section, San Francisco VA Medical Center, Department of Nephrology, University of California, San Francisco, CA 94121, USA.
Insights
Mild declines in kidney function, measured by cystatin C, are linked to poorer physical function in older adults. This contrasts with creatinine measures, highlighting cystatin C
Area of Science:
- Gerontology
- Nephrology
- Physical Medicine
Background:
- Previous research on kidney function and physical function primarily focused on advanced kidney disease using creatinine.
- Creatinine-based kidney function measures are influenced by muscle mass, potentially confounding results in diverse populations.
Purpose of the Study:
- To investigate the association between cystatin C-based kidney function and physical function in a cohort of elderly adults.
- To compare the utility of cystatin C versus estimated glomerular filtration rate (eGFR) in detecting links between kidney function and physical performance.
Main Methods:
- Cross-sectional analysis of baseline data from 3,043 elderly participants in the Health, Aging, and Body Composition Study.
- Assessed physical function through 400-m walk tests, lower extremity performance scores, grip strength, and knee extension strength.
- Adjusted for demographic, lifestyle, chronic health, and inflammation variables.
Main Results:
- Increased cystatin C levels were significantly associated with poorer performance in all measured physical function tests.
- Each standard deviation increase in cystatin C correlated with increased odds of not completing the 400-m walk and slower walk times.
- Reduced cystatin C was linked to lower scores in lower extremity performance, grip strength, and knee extension strength.
- Associations between eGFR and physical function were only apparent at eGFR levels below 60 ml/minute/1.73 m2.
Conclusions:
- Mild reductions in kidney function, as indicated by cystatin C, are associated with diminished physical function in older adults.
- Cystatin C offers a more sensitive marker than creatinine-based eGFR for detecting the impact of early kidney function decline on physical performance in the elderly.
Abstract:
Most studies of the relation between kidney function and physical function have been conducted in persons with advanced kidney disease and have used creatinine-based measures of kidney function. Cystatin C concentration is a measure of kidney function that is independent of muscle mass, unlike creatinine. Using baseline data on 3,043 elderly adults from the Health, Aging, and Body Composition Study (Blacks and Whites recruited from Pittsburgh, Pennsylvania, and Memphis, Tennessee, in 1997-1998), the authors examined the cross-sectional association between cystatin C level and performance on several tests of physical function. After adjustment for demographic and lifestyle variables, chronic health conditions, and inflammation, each standard-deviation (0.34 mg/liter) increase in cystatin C concentration was associated with 1.32 odds (95% confidence interval (CI): 1.20, 1.46) of not completing a 400-m walk, a 10.9-second (95% CI: 8.1, 13.8) slower 400-m walk time, a 0.11-point (95% CI: 0.09, 0.13) reduction in lower extremity performance score, a 1.12-kg (95% CI: 0.83, 1.40) lower grip strength, and a 4.7-nm (95% CI: 3.5, 5.9) lower knee extension strength. In contrast, when kidney function was measured by estimated glomerular filtration rate, the association of kidney function with physical function was only evident below 60 ml/minute/1.73 m2. In these older adults, mild decrements in kidney function, as measured by cystatin C concentration, were associated with poorer physical function.
