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

Per-Ola Sundin1, Per Sjöström1, Ian Jones1

  • 1School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|March 25, 2017
PubMed

Insights

Cystatin C and creatinine levels independently predict mortality risk, even beyond measured glomerular filtration rate (mGFR). Combining these markers offers a more precise assessment than mGFR alone.

Area of Science:

  • Nephrology
  • Clinical Chemistry
  • Epidemiology

Background:

  • Cystatin C may offer insights into mortality beyond glomerular filtration rate (GFR).
  • Assessing cystatin C's independent association with mortality is limited by multicollinearity with GFR markers.
  • Previous studies have not firmly established cystatin C's independent prognostic value.

Purpose of the Study:

  • To assess the association between cystatin C and mortality, independent of measured GFR (mGFR).
  • To evaluate the combined utility of cystatin C and creatinine in predicting mortality risk.

Main Methods:

  • Cox regression analysis was employed.
  • The study included 1157 individuals referred for plasma clearance of iohexol assessment.
  • Cystatin C and creatinine were analyzed as cystatin C - 1 and creatinine - 1 to account for their inverse relationship with mGFR.

Main Results:

  • Higher cystatin C concentration (lower cystatin C - 1) and lower creatinine concentration (higher creatinine - 1) were independently associated with increased mortality after mGFR adjustment.
  • The independence of these associations was supported by nested model comparisons, mitigating multicollinearity concerns.
  • A combined model of cystatin C - 1 and creatinine - 1 explained the largest proportion of variance in mortality risk (R² = 0.61), outperforming models including mGFR.

Conclusions:

  • Both creatinine and cystatin C demonstrate independent associations with mortality, not fully explained by mGFR.
  • Measured GFR does not provide a more precise mortality risk assessment compared to combining cystatin C and creatinine.
Abstract

Keywords:
GFRcreatininecystatin Cepidemiologyprognosis

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