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Different cardiovascular risks associated with elevated creatinine-based eGFR and cystatin C-based eGFR
Mengyi Liu1, Ziliang Ye1, Panpan He1
1Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, 510515, Guangzhou, China.
Insights
Elevated kidney function markers show differing cardiovascular risks. High creatinine-based eGFR (eGFRcr) increases cardiovascular disease (CVD) risk, while high cystatin C-based eGFR (eGFRcys) lowers it. Both reduce chronic kidney disease (CKD) risk.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Estimated glomerular filtration rate (eGFR) is crucial for assessing kidney function.
- Two common markers, creatinine (eGFRcr) and cystatin C (eGFRcys), are used to estimate eGFR.
- The association of elevated eGFR with cardiovascular disease (CVD) and chronic kidney disease (CKD) risk requires further clarification.
Purpose of the Study:
- To compare the association of elevated eGFRcr and eGFRcys with the risk of incident CVD and CKD.
- To investigate differential risks associated with high kidney function estimates based on creatinine versus cystatin C.
Main Methods:
- A cohort study of 372,060 participants from the UK Biobank, initially free of CVD and CKD.
- Participants categorized into low, normal, and high eGFR groups based on age- and sex-specific percentiles.
- Primary outcome: incident CVD (ischemic heart disease, stroke, heart failure, atrial fibrillation) over a median 12.4-year follow-up.
Main Results:
- High eGFRcr was associated with a significantly higher risk of CVD (HR, 1.19).
- High eGFRcys was associated with a significantly lower risk of CVD (HR, 0.90).
- Both high eGFRcr and high eGFRcys were associated with a lower risk of CKD.
Conclusions:
- Elevated eGFRcr is linked to increased CVD risk, contrasting with eGFRcys which is linked to decreased CVD risk.
- Both markers of elevated kidney function are associated with a reduced risk of developing CKD.
- These findings highlight the importance of the eGFR estimation method in risk assessment for CVD and CKD.
Abstract:
To compare the association of elevated estimated glomerular filtration rate (eGFR) based on creatinine (eGFRcr) and cystatin C (eGFRcys) with the risk of cardiovascular diseases (CVD) and chronic kidney diseases (CKD). 372,060 participants free of CVD and CKD in the UK Biobank were included. Participants were categorized into low, normal and high eGFR groups according to the age- and sex-specific 5th and 95th percentiles of eGFR. The primary outcome was incident CVD, defined as a combination of ischemic heart disease, stroke, heart failure, and atrial fibrillation. Thresholds for high eGFR varied with age and sex, ranging from 96.5 to 116.0 mL/min/1.73 m2 and 100.3 to 120.1 mL/min/1.73 m2 for eGFRcr and eGFRcys, respectively. During a median follow-up of 12.4 years, 39,855 (10.7%) participants developed CVD. Compared with normal eGFR levels, high eGFRcr levels were associated with a higher risk of CVD (HR, 1.19; 95% CI: 1.14-1.25), while high eGFRcys levels were associated with a lower risk of CVD (HR, 0.90; 95% CI: 0.85-0.95). Compared to normal eGFR levels, both high eGFRcr and high eGFRcys levels were related to a lower risk of CKD. Elevated eGFRcr levels were associated with a higher risk of CVD, and elevated eGFRcys levels were associated with a lower risk of CVD.
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