Discrepancy between cystatin C-based and creatinine-based eGFR predicts all-cause mortality in a community-based...

Area of Science:

• Nephrology
• Epidemiology
• Gerontology

Background:

• Discrepancies between cystatin C-eGFR (eGFRcys) and creatinine-eGFR (eGFRcr) are linked to adverse outcomes in Western populations.
• Prognostic significance of eGFR discrepancies in community-dwelling Japanese individuals is not well understood.

Purpose of the Study:

• To evaluate the association between eGFR discrepancies and mortality in a Japanese cohort.
• To determine if eGFRdiff is an independent predictor of all-cause and cardiovascular mortality.

Main Methods:

• Prospective cohort study of 1308 Japanese participants with simultaneous eGFRcys and eGFRcr measurements.
• Categorization of eGFR discrepancy (eGFRdiff = eGFRcys - eGFRcr) into low (< -10), reference (-10 to 10), and high (≥ 10) groups.
• Assessment of all-cause and cardiovascular mortality using survival analyses over a median follow-up of 18.5 years.

Main Results:

• A total of 386 deaths (29.5%) occurred, including 120 cardiovascular deaths.
• The low eGFRdiff group (< -10) showed significantly higher all-cause mortality (HR: 1.41; 95% CI: 1.10-1.80).
• The high eGFRdiff group (≥ 10) showed a lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.33-0.97).
• eGFRdiff improved discrimination for both all-cause and cardiovascular mortality when added to baseline models.

Conclusions:

• eGFR discrepancy is an independent predictor of all-cause mortality in community-dwelling Japanese individuals.
• eGFRdiff serves as a simple and informative marker for identifying individuals at increased risk of death.
• Further research may explore the clinical utility of eGFRdiff in risk stratification.