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A High-throughput Method for Measurement of Glomerular Filtration Rate in Conscious Mice
Published on: May 10, 2013
Discordance between Cystatin C-Based and Creatinine-Based Estimated Glomerular Filtration Rate and Mortality in the
Qiaoling Liu1,2, Carlos Celis-Morales1,3,4, Jennifer S Lees1
1School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
Insights
Discrepancies between cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates are common and linked to mortality risk in the general population. Lower eGFRcys indicates a higher risk of death.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Estimated glomerular filtration rate (eGFR) is crucial for assessing kidney function.
- Discordance between cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) eGFR is increasingly recognized.
- The association of eGFR discordance with all-cause mortality in the general population remains underexplored.
Purpose of the Study:
- To investigate the prevalence of eGFR discordance in a large general population.
- To examine the association between eGFR discordance and all-cause mortality.
Main Methods:
- Utilized UK Biobank data from 325,356 participants (40-69 years).
- Calculated eGFR using CKD-EPI and EKFC equations for both cystatin C and creatinine.
- Defined discordance based on absolute (±15 mL/min/1.73 m²) and relative (eGFRcys < 60% eGFRcr) differences.
- Employed multivariable Cox proportional hazards models to estimate mortality risk.
Main Results:
- 15.5% of participants showed discordant lower absolute eGFRcys; 8.5% showed discordant higher absolute eGFRcys.
- Discordant lower eGFRcys was associated with older age, male sex, higher BMI, higher blood pressure, more comorbidities, and less physical activity.
- Participants with discordant lower eGFRcys had a 53% higher mortality risk (HR=1.53).
- Those with discordant higher eGFRcys had a 30% lower mortality risk (HR=0.70).
- Discordance of lower relative eGFRcys doubled the mortality risk (HR=2.25).
Conclusions:
- eGFR discordance is prevalent in the general population.
- eGFR discordance is significantly associated with all-cause mortality.
- Cystatin C-based eGFR may improve mortality risk stratification.
Background:
The consequences for health outcomes of the discordance in cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates are gaining attention. However, the association of discordance with all-cause mortality in the general population has not been explored.
Methods:
A total of 325 356 UK Biobank participants, 40 to 69 years of age, were followed for a median of 13.7 years. eGFR was calculated using both the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009/2012 equations and the European Kidney Function Consortium (EKFC) equations. Differences were expressed as the absolute difference (eGFRcys - eGFRcr, where discordance was defined as ±15 mL/min/1.73 m2 difference) and relative difference (eGFRcys/eGFRcr, where discordance was defined as eGFRcys < 60% eGFRcr). Hazard ratios (HRs) for mortality were estimated using multivariable Cox proportional hazards models.
Results:
Among the participants, 15.5% had a discordant lower absolute eGFRcys, and 8.5% had a discordant higher absolute eGFRcys. Participants with discordant lower absolute eGFRcys (both CKD-EPI and EKFC equations) were older, more frequently male, had higher body mass index (BMI) and blood pressure, more comorbidities, and did less physical activity. A total of 26 465 deaths occurred. Participants with discordant lower eGFRcys had a 53% higher risk of mortality (HR = 1.53: 95% CI, 1.48-1.57), while those with discordant higher eGFRcys had a 30% lower risk (HR = 0.70: 95% CI, 0.66-0.75) compared to those with concordant eGFR. Those with discordance of lower relative eGFRcys had doubled risk of mortality (HR = 2.25: 95% CI, 2.04-2.47).
Conclusions:
eGFR discordance was prevalent and associated with mortality in general populations. These results support broader use of cystatin C for risk stratification of mortality.
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