TY - JOUR
T1 - Estimating the glomerular filtration rate from serum creatinine is better than from cystatin C for evaluating risk factors associated with chronic kidney disease
AU - Rule, Andrew D.
AU - Bailey, Kent R.
AU - Lieske, John C.
AU - Peyser, Patricia A.
AU - Turner, Stephen T.
N1 - Funding Information:
We appreciate the help by Daniel Crusan with programming the statistical analyses. This project was supported by research grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; DK078229 and DK073537) and made possible by the Rochester Epidemiology Project (AG034676) from the National Institutes of Health, US Public Health Service.
PY - 2013/6
Y1 - 2013/6
N2 - Chronic kidney disease risk factors may associate with the estimated glomerular filtration rate (eGFR) differently than with the measured GFR. To examine this, we evaluated 1150 patients (mean age 65 years) in two community cohorts for risk factors, measured GFR by iothalamate clearance, and eGFR based on creatinine (Cr), cystatin C (CysC), or both. The interaction between each risk factor and eGFR (relative to measured GFR) identified risk factor associations with eGFR along non-GFR pathways. In a subset of 40 patients with two visits, the mean coefficient of variation was 8.2% for measured GFR, 6.4% for eGFR Cr, 8.2% for eGFR Cr-CysC, and 10.7% for eGFR CysC. The measured GFR was better correlated with eGFR Cr-CysC (r, 0.74) than eGFR Cr (r, 0.70) or eGFR CysC (r, 0.68). Lower measured GFR associated with lower 24-hour urine creatinine, albuminuria, hypertension, diabetes, higher triglycerides, and higher uric acid. Lower eGFR Cr had these same associations except for an association with higher 24-hour urine creatinine along a non-GFR pathway. Lower eGFR CysC and eGFR Cr-CysC also had these same associations but also associated with obesity, albuminuria, hypertension, diabetes, higher triglycerides, higher C-reactive protein, and higher uric acid along non-GFR pathways. Thus, cystatin C improves estimation of GFR over creatinine alone; however, the association between most of the risk factors and GFR was more accurate by eGFR based on creatinine alone. This is explained by the association of these risk factors with the non-GFR determinants of cystatin C.
AB - Chronic kidney disease risk factors may associate with the estimated glomerular filtration rate (eGFR) differently than with the measured GFR. To examine this, we evaluated 1150 patients (mean age 65 years) in two community cohorts for risk factors, measured GFR by iothalamate clearance, and eGFR based on creatinine (Cr), cystatin C (CysC), or both. The interaction between each risk factor and eGFR (relative to measured GFR) identified risk factor associations with eGFR along non-GFR pathways. In a subset of 40 patients with two visits, the mean coefficient of variation was 8.2% for measured GFR, 6.4% for eGFR Cr, 8.2% for eGFR Cr-CysC, and 10.7% for eGFR CysC. The measured GFR was better correlated with eGFR Cr-CysC (r, 0.74) than eGFR Cr (r, 0.70) or eGFR CysC (r, 0.68). Lower measured GFR associated with lower 24-hour urine creatinine, albuminuria, hypertension, diabetes, higher triglycerides, and higher uric acid. Lower eGFR Cr had these same associations except for an association with higher 24-hour urine creatinine along a non-GFR pathway. Lower eGFR CysC and eGFR Cr-CysC also had these same associations but also associated with obesity, albuminuria, hypertension, diabetes, higher triglycerides, higher C-reactive protein, and higher uric acid along non-GFR pathways. Thus, cystatin C improves estimation of GFR over creatinine alone; however, the association between most of the risk factors and GFR was more accurate by eGFR based on creatinine alone. This is explained by the association of these risk factors with the non-GFR determinants of cystatin C.
KW - Chronic kidney disease
KW - Clinical
KW - Creatinine
KW - Epidemiology
KW - Glomerular filtration rate
UR - http://www.scopus.com/inward/record.url?scp=84882240321&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84882240321&partnerID=8YFLogxK
U2 - 10.1038/ki.2013.7
DO - 10.1038/ki.2013.7
M3 - Article
C2 - 23423253
AN - SCOPUS:84882240321
SN - 0085-2538
VL - 83
SP - 1169
EP - 1176
JO - Kidney international
JF - Kidney international
IS - 6
ER -