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[High serum cystatin C is an independent risk factor for poor renal prognosis in IgA nephropathy]
Tianwei Tang1, Luan Li2, Yuanhan Chen2
1Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Insights
Elevated serum cystatin C (CysC) levels indicate a poorer renal prognosis in IgA nephropathy (IgAN) patients. High CysC is an independent risk factor for kidney disease progression and end-stage renal disease in IgAN.
Area of Science:
- Nephrology
- Biomarker Research
- Clinical Prognostics
Context:
- IgA nephropathy (IgAN) is a common glomerular disease with variable clinical outcomes.
- Accurate prediction of renal prognosis is crucial for managing IgAN patients.
- Serum cystatin C (CysC) is a potential biomarker for kidney function, but its prognostic value in IgAN requires further investigation.
Purpose:
- To evaluate the association between serum cystatin C (CysC) levels and renal prognosis in patients with IgA nephropathy (IgAN).
Summary:
- This retrospective study analyzed 356 IgAN patients, dividing them into high (>1.03 mg/L) and normal (≤1.03 mg/L) serum CysC groups.
- High serum CysC was identified as an independent risk factor for poor renal prognosis (composite endpoint: ≥50% eGFR decline and/or ESRD), with a hazard ratio of 2.142.
- A nomogram model incorporating serum CysC demonstrated good predictive performance (AUC 0.909) for renal outcomes.
Impact:
- Serum CysC levels provide valuable prognostic information for IgAN patients.
- High serum CysC is a significant independent risk factor for adverse renal outcomes in IgAN.
- The developed nomogram can aid clinicians in risk stratification and personalized management of IgAN patients.
Objectives:
To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients.
Methods:
We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC).
Results:
A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (HR=2.142, 95% CI 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ2=47.970, P<0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (β=3.487, 95% CI: 2.561-4.413, P<0.001), while above this level, the increase of the risk was not significant (β=0.676, 95% CI: -0.642-1.995, P=0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% CI: 0.839-0.907) and an AUC of 0.909 (95% CI: 0.873-0.945).
Conclusions:
Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
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