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The Discrepancy Between Estimated GFR Cystatin C and Estimated GFR Creatinine at 3 Months After Hospitalization and
Yumeng Wen1, Nityasree Srialluri1, Danielle Farrington1
1Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
The difference between cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates in hospitalized adults predicts risks for heart failure, end-stage kidney disease, and death. This eGFR discrepancy offers valuable prognostic insights.
Area of Science:
- Nephrology
- Cardiology
- Clinical Epidemiology
Background:
- The prognostic significance of discrepancies between cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates in recently hospitalized patients is not well-established.
- Understanding these differences is crucial for accurate risk stratification and patient management.
Purpose of the Study:
- To characterize the difference between eGFRcys and eGFRcr in hospitalized adults three months post-discharge.
- To investigate the association between eGFR discrepancies and adverse outcomes, including end-stage kidney disease (ESKD), major atherosclerotic cardiac events (MACE), heart failure hospitalization, and mortality.
Main Methods:
- A cohort of 1534 hospitalized adults was studied, with 767 patients who developed acute kidney injury (AKI) matched 1:1 with those who did not.
- Survival analysis was employed to assess the relationship between a lower eGFRcys compared to eGFRcr and the risk of specific adverse outcomes.
- Follow-up extended for a median of 4.7 years.
Main Results:
- A significant difference was observed between eGFRcr (median 71.5 ml/min/1.73 m²) and eGFRcys (median 50.5 ml/min/1.73 m²), with a median absolute difference of -16.3 ml/min/1.73 m².
- eGFRcys being at least 30% lower than eGFRcr was associated with increased risks of heart failure hospitalization (aHR: 1.41), ESKD (aHR: 1.95), and death (aHR: 2.09).
- These associations remained consistent regardless of whether participants had AKI or not.
Conclusions:
- The discrepancy between eGFRcys and eGFRcr serves as a significant prognostic marker in recently hospitalized patients.
- This eGFR difference can aid in risk stratification and guide the implementation of targeted interventions.
- The findings highlight the clinical utility of assessing both eGFR markers for comprehensive patient assessment.
Introduction:
The prognostic value of the discrepancy between the estimated glomerular filtration rate (eGFR) using cystatin C (eGFRcys) and creatinine (eGFRcr) in recently hospitalized adults remains poorly understood.
Methods:
We characterized the difference between eGFRcys and eGFRcr, at 3 months after discharge, in 1534 hospitalized adults; 767 (50%) with acute kidney injury (AKI) matched 1:1 with patients who did not develop AKI. We used survival analysis to determine the associations between having lower eGFRcys than eGFRcr with risk of end-stage kidney disease (ESKD), major atherosclerotic cardiac events (MACE), heart failure hospitalization, and death after a a median follow-up of 4.7 years.
Results:
The mean age of study participants was 65.8 years, and 37.3% were female. At 3 months after hospitalization, the median (interquartile range [IQR]) eGFRcr and eGFRcys were 71.5 (51.9-92.6) and 50.5 (34.1-71.9) ml/min per 1.73 m2, respectively, with a median (IQR) absolute difference of -16.3 (-26.1 to -6.3) ml/min per 1.73 m2 and percent difference of -26% (-39% to -11%). The presence of eGFRcys at least 30% lower than eGFRcr at 3 months was associated with a higher risk of heart failure hospitalization (adjusted hazard ratio [aHR]: 1.41, 95% confidence interval [CI]: 1.06-1.89), ESKD (aHR: 1.95, 95% CI: 1.02-3.72), and death (aHR: 2.09, 95% CI: 1.64-2.67), and these associations were consistent in participants with and without AKI (P for interaction with AKI all > 0.1).
Conclusion:
Our findings suggest that the eGFRcys-eGFRcr discrepancy may serve as a valuable prognostic marker in recently hospitalized patients, informing risk stratification and potential interventions.
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