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Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and
Carmen A Peralta1, Michael G Shlipak, Suzanne Judd
1Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA. carmenalicia.peralta@ucsf.edu
JAMA
|April 13, 2011
Summary
Adding cystatin C to creatinine and urine albumin-to-creatinine ratio (ACR) tests significantly improves chronic kidney disease (CKD) risk prediction for mortality and end-stage renal disease.
Area of Science:
- Nephrology
- Clinical Chemistry
- Epidemiology
Background:
- Chronic kidney disease (CKD) evaluation traditionally relies on markers like creatinine.
- A comprehensive triple-marker approach for CKD assessment remains understudied.
Purpose of the Study:
- To determine if combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) enhances CKD risk identification compared to creatinine alone.
- To assess the predictive value of a multi-biomarker strategy for adverse kidney outcomes.
Main Methods:
- A prospective cohort study of 26,643 US adults from the REGARDS study (2003-2010).
- Participants were stratified by estimated glomerular filtration rate (eGFR) using creatinine and cystatin C, and by ACR.
- Outcomes included all-cause mortality and incident end-stage renal disease over a median follow-up of 4.6 years.
Main Results:
- The triple-marker approach identified more individuals with CKD compared to creatinine alone.
- Combining all three biomarkers (creatinine, cystatin C, ACR) showed the highest hazard ratios for mortality (HR=5.6) and end-stage renal disease.
- Net reclassification improvement for death (13.3%) and end-stage renal disease (6.4%) was significant after adding cystatin C.
Conclusions:
- Incorporating cystatin C alongside creatinine and ACR substantially improves the prediction of mortality and end-stage renal disease in CKD.
- A multi-biomarker strategy offers superior risk stratification for chronic kidney disease.
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