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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event
Debbie C Chen1,2,3, Jennifer S Lees4,5, Kaiwei Lu2,6
1Division of Nephrology, Department of Medicine University of California, San Francisco San Francisco CA.
Insights
Cystatin C-based kidney function tests identify more South Asians at high risk for cardiovascular disease and mortality than creatinine-based tests. This improves risk stratification for heart failure and atherosclerotic cardiovascular disease.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- South Asian populations exhibit elevated risks for cardiovascular disease (CVD) and mortality.
- Standard creatinine-based estimated glomerular filtration rate (eGFR) may underestimate CVD risk in chronic kidney disease (CKD).
Purpose of the Study:
- To compare the performance of cystatin C-based eGFR (eGFRcys) versus creatinine-based eGFR in risk stratification for CVD and mortality in South Asians.
- To identify CKD patients at higher risk who may be missed by creatinine-based assessments.
Main Methods:
- Analysis of 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic CVD.
- Investigation of associations between four eGFR categories (using both cystatin C and creatinine) and risks of all-cause mortality, incident HF, and incident atherosclerotic CVD.
- Multivariable adjustment for confounding factors.
Main Results:
- Cystatin C identified significantly more participants with eGFR <60 mL/min/1.73 m² compared to creatinine.
- An eGFRcys of 45-59 mL/min/1.73 m² was associated with increased mortality (HR 2.38) and incident HF (sHR 1.87) risk, unlike the creatinine-based eGFR.
- Reclassification using eGFRcys revealed substantially higher risks for mortality, HF, and atherosclerotic CVD in lower eGFR categories.
Conclusions:
- Cystatin C-based eGFR is superior to creatinine-based eGFR for identifying high-risk CKD individuals in the South Asian population.
- Utilizing eGFRcys enhances the accuracy of risk stratification for major adverse cardiovascular events and mortality.
- This approach can improve early detection and management strategies for at-risk South Asian individuals.
Abstract:
Background South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine- rather than cystatin C-based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Methods and Results Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m2) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55-3.65]) and incident HF (sub-HR [sHR], 1.87 [95% CI, 1.09-3.22]) versus the eGFRcys ≥90 category; the creatinine-based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine-based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56-9.31]), incident HF (sHR, 4.96 [95% CI, 2.21-11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14-4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45-3.51]). Conclusions Among South Asian individuals, cystatin C identified a high-risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate-based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.
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