Abstract
Background
The diagnosis of renal failure is important in cirrhosis. Cystatin C (Cys) has been suggested not only to be a sensitive marker of renal function, but also a stronger predictor of the risk of death and cardiovascular events in heart failure. Our aims were to investigate plasma Cys concentrations for the detection of moderately impaired renal function and its association with mortality and cardiovascular events among cirrhotic patients after liver transplantation (OLT).
Methods
Clinical and biochemical data, including Cys levels, were analyzed in 99 cirrhotic candidates for OLT. We recorded cardiovascular events.
Results
Receiver-operator characteristics curves showed a similar efficiency to detect a creatinine clearance <60 mL/min per 1.73m2 (Cys = 0.753; creatinine [Cr] = 0.799; glomerular filtration rate [GFR, Cockcroft–Gault formula] = 0.842; urea = 0.823; P = .001). However, at cutoff concentrations of 1.3 mg/dL, Cr showed great specificity (96%) but poor sensitivity (13%), while the sensitivity of Cys was superior (83%) with moderate specificity (55%) at a cutoff of 1400 ng/mL. Over a median follow-up of 2.7 years, 14 patients developed a cardiovascular event, including, 11 who displayed Cys levels >1400 ng/mL before OLT, showing a significant difference (P < .05) compared to patients who showed no cardiovascular event. Kaplan–Meier analysis Cys discriminated significantly better than the Model for End-Stage Liver Disease score between survivors and nonsurvivors (P < .05).
Conclusion
Cys determinations could be a valuable tool for early diagnosis of renal dysfunction among cirrhotic patients. Furthermore, it may predict the risk of death and cardiovascular events after OLT.
Transplantation Proceedings
Volume 43, Issue 3, April 2011, Pages 732-734
Tuesday
Monday
Cystatin C, a marker for successful aging and glomerular filtration rate, is not influenced by inflammation
Abstract
Background. The plasma level of cystatin C is a better marker than plasma creatinine for successful aging. It has been assumed that the advantage of cystatin C is not only due to it being a better marker for glomerular filtration rate (GFR) than creatinine, but also because an inflammatory state of a patient induces a raised cystatin C level. However, the observations of an association between cystatin C level and inflammation stem from large cohort studies. The present work concerns the cystatin C levels and degree of inflammation in longitudinal studies of individual subjects without inflammation, who undergo elective surgery.
Methods. Cystatin C, creatinine, and the inflammatory markers CRP, serum amyloid A (SAA), haptoglobin and orosomucoid were measured in plasma samples from 35 patients the day before elective surgery and subsequently during seven consecutive days.
Results. Twenty patients had CRP-levels below 1 mg/L before surgery and low levels of the additional inflammatory markers. Surgery caused marked inflammation with high peak values of CRP and SAA on the second day after the operation. The cystatin C level did not change significantly during the observation period and did not correlate significantly with the level of any of the four inflammatory markers. The creatinine level was significantly reduced on the first postoperative day but reached the preoperative level towards the end of the observation period.
Conclusion. The inflammatory status of a patient does not influence the role of cystatin C as a marker of successful aging, nor of GFR.
Anders Grubb1, Jonas Björk2, Ulf Nyman3, Joanna Pollak1,5, Johan Bengzon4, Gustav Östner1 & Veronica Lindström1
Department of Clinical Chemistry, Lund University Hospital, Lund, Sweden
Competence Centre for Clinical Research, Lund University Hospital, Lund, Sweden
Department of Radiology, University of Lund, Lasarettet Trelleborg, Trelleborg, Sweden
Department of Neurosurgery, Lund University Hospital, Lund, Sweden
Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
Background. The plasma level of cystatin C is a better marker than plasma creatinine for successful aging. It has been assumed that the advantage of cystatin C is not only due to it being a better marker for glomerular filtration rate (GFR) than creatinine, but also because an inflammatory state of a patient induces a raised cystatin C level. However, the observations of an association between cystatin C level and inflammation stem from large cohort studies. The present work concerns the cystatin C levels and degree of inflammation in longitudinal studies of individual subjects without inflammation, who undergo elective surgery.
Methods. Cystatin C, creatinine, and the inflammatory markers CRP, serum amyloid A (SAA), haptoglobin and orosomucoid were measured in plasma samples from 35 patients the day before elective surgery and subsequently during seven consecutive days.
Results. Twenty patients had CRP-levels below 1 mg/L before surgery and low levels of the additional inflammatory markers. Surgery caused marked inflammation with high peak values of CRP and SAA on the second day after the operation. The cystatin C level did not change significantly during the observation period and did not correlate significantly with the level of any of the four inflammatory markers. The creatinine level was significantly reduced on the first postoperative day but reached the preoperative level towards the end of the observation period.
Conclusion. The inflammatory status of a patient does not influence the role of cystatin C as a marker of successful aging, nor of GFR.
Anders Grubb1, Jonas Björk2, Ulf Nyman3, Joanna Pollak1,5, Johan Bengzon4, Gustav Östner1 & Veronica Lindström1
Department of Clinical Chemistry, Lund University Hospital, Lund, Sweden
Competence Centre for Clinical Research, Lund University Hospital, Lund, Sweden
Department of Radiology, University of Lund, Lasarettet Trelleborg, Trelleborg, Sweden
Department of Neurosurgery, Lund University Hospital, Lund, Sweden
Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
Wednesday
Serum Cystatin C Is an Early Predictive Biomarker of Acute Kidney Injury after Pediatric Cardiopulmonary Bypass
Background and objectives: Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass (CPB). Serum creatinine (SCr), the current standard, is an inadequate marker for AKI since a delay occurs before SCr rises. Biomarkers that are sensitive and rapidly measurable could allow early intervention and improve patient outcomes. We investigated the value of serum cystatin C as an early biomarker for AKI after pediatric CPB.
Design, setting, participants, & measurements: We analyzed data from 374 prospectively enrolled children undergoing CPB. Serum samples were obtained before and at 2, 12, and 24 hours after CPB. Cystatin C was quantified by nephelometry. The primary outcome was AKI, defined as a 50% increase in SCr. Secondary outcomes included severity and duration of AKI, hospital length of stay, and mortality. A multivariable stepwise logistic regression analysis was used to assess predictors of AKI.
Results: One hundred nineteen patients (32%) developed AKI using SCr criteria. Serum cystatin C concentrations were significantly increased in AKI patients at 12 hours after CPB (P < 0.0001) and remained elevated at 24 hours (P < 0.0001). Maximal sensitivity and specificity for prediction of AKI occurred at a 12-hour cystatin C cut-off of 1.16 mg/L. The 12-hour cystatin C strongly correlated with severity and duration of AKI as well as length of hospital stay. In multivariable analysis, 12-hour cystatin C remained a powerful independent predictor of AKI.
Conclusion: Serum cystatin C is an early predictive biomarker for AKI and its clinical outcomes after pediatric CPB
Catherine D. Krawczeski*, Rene G. Vandevoorde, Thelma Kathman, Michael R. Bennett, Jessica G. Woo, Yu Wang, Rachel E. Griffiths*, and Prasad Devarajan
* The Heart Institute and the Divisions of Nephrology and Hypertension and Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
Design, setting, participants, & measurements: We analyzed data from 374 prospectively enrolled children undergoing CPB. Serum samples were obtained before and at 2, 12, and 24 hours after CPB. Cystatin C was quantified by nephelometry. The primary outcome was AKI, defined as a 50% increase in SCr. Secondary outcomes included severity and duration of AKI, hospital length of stay, and mortality. A multivariable stepwise logistic regression analysis was used to assess predictors of AKI.
Results: One hundred nineteen patients (32%) developed AKI using SCr criteria. Serum cystatin C concentrations were significantly increased in AKI patients at 12 hours after CPB (P < 0.0001) and remained elevated at 24 hours (P < 0.0001). Maximal sensitivity and specificity for prediction of AKI occurred at a 12-hour cystatin C cut-off of 1.16 mg/L. The 12-hour cystatin C strongly correlated with severity and duration of AKI as well as length of hospital stay. In multivariable analysis, 12-hour cystatin C remained a powerful independent predictor of AKI.
Conclusion: Serum cystatin C is an early predictive biomarker for AKI and its clinical outcomes after pediatric CPB
Catherine D. Krawczeski*, Rene G. Vandevoorde, Thelma Kathman, Michael R. Bennett, Jessica G. Woo, Yu Wang, Rachel E. Griffiths*, and Prasad Devarajan
* The Heart Institute and the Divisions of Nephrology and Hypertension and Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
Monday
Cystatin C and Sudden Cardiac Death Risk in the Elderly
Methods and Results: The study was a longitudinal analysis among 4465 participants from the Cardiovascular Health Study without prevalent cardiovascular disease at baseline. Cystatin C and creatinine were measured from baseline sera. Sudden cardiac death (SCD) was defined as a sudden pulseless condition from a cardiac origin in a previously stable individual that occurred out of the hospital or in the emergency room. The association between cystatin C tertiles and SCD was determined with multivariate Cox proportional hazards. A similar analysis compared SCD incidence across creatinine-based estimated glomerular filtration rate (eGFR) tertiles. Over a median follow-up of 11.2 years, 91 adjudicated SCD events occurred. The annual incidence of SCD events increased across cystatin C tertiles: 10 events per 10000 person years in tertile 1, 25 events per 10000 person years in tertile 2, and 32 events per 10000 person-years in the highest cystatin C tertile. These associations persisted after multivariate adjustment: hazards ratio=2.72; 95% confidence interval, 1.44 to 5.16 in tertile 2 and hazards ratio=2.67; 95% confidence interval, 1.33 to 5.35 in tertile 3. After multivariate adjustment, the rate of SCD also increased in a linear distribution across creatinine-based eGFR tertiles: 15 events per 10000 person-years in tertile 1, 22 events per 10000 person-years in tertile 2, and 27 events per 10000 person-years in tertile 3. No significant associations, however, remained between creatinine-based eGFR and SCD after multivariable adjustment.
Conclusions: Impaired kidney function, as measured by cystatin C, has an independent association with SCD risk among elderly persons without clinical cardiovascular disease.
Rajat Deo, MD; Nona Sotoodehnia, MD, MPH; Ronit Katz, DPhil; Mark J. Sarnak, MD, MS; Linda F. Fried, MD, MPH; Michel Chonchol, MD; Bryan Kestenbaum, MD; Bruce M. Psaty, MD, PhD; David S. Siscovick, MD, MPH and Michael G. Shlipak, MD, MPH
From the Division of Cardiology (R.D.), University of Pennsylvania, Philadelphia;
the Division of Cardiology (N.S.), University of Washington, Seattle; Collaborative Health Studies Coordinating Center (R.K.), University of Washington, Seattle; the Division of Nephrology (M.J.S.), Tufts Medical Center, Boston, Mass;
The Renal-Electrolyte Division (L.F.F.), University of Pittsburgh School of Medicine, and the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pa; the Division of Renal Diseases and Hypertension (M.C.), University of Colorado Health Sciences Center, Denver; the Division of Nephrology (B.K.), University of Washington, Veterans Affairs Puget Sound Health Care System, Seattle, Wash; the Cardiovascular Health Research Unit (B.M.P., D.S.S.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle; Center for Health Studies, Group Health, Seattle, Wash; and General Internal Medicine Section (M.G.S.), Veterans Affairs Medical Center, San Francisco, Calif, and Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco.
Conclusions: Impaired kidney function, as measured by cystatin C, has an independent association with SCD risk among elderly persons without clinical cardiovascular disease.
Rajat Deo, MD; Nona Sotoodehnia, MD, MPH; Ronit Katz, DPhil; Mark J. Sarnak, MD, MS; Linda F. Fried, MD, MPH; Michel Chonchol, MD; Bryan Kestenbaum, MD; Bruce M. Psaty, MD, PhD; David S. Siscovick, MD, MPH and Michael G. Shlipak, MD, MPH
From the Division of Cardiology (R.D.), University of Pennsylvania, Philadelphia;
the Division of Cardiology (N.S.), University of Washington, Seattle; Collaborative Health Studies Coordinating Center (R.K.), University of Washington, Seattle; the Division of Nephrology (M.J.S.), Tufts Medical Center, Boston, Mass;
The Renal-Electrolyte Division (L.F.F.), University of Pittsburgh School of Medicine, and the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pa; the Division of Renal Diseases and Hypertension (M.C.), University of Colorado Health Sciences Center, Denver; the Division of Nephrology (B.K.), University of Washington, Veterans Affairs Puget Sound Health Care System, Seattle, Wash; the Cardiovascular Health Research Unit (B.M.P., D.S.S.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle; Center for Health Studies, Group Health, Seattle, Wash; and General Internal Medicine Section (M.G.S.), Veterans Affairs Medical Center, San Francisco, Calif, and Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco.
Friday
Kidney function estimated from serum creatinine and cystatin C and peripheral arterial disease
Aims: Serum cystatin C, a novel marker of kidney function, is reported to be superior to serum creatinine as a risk factor for atherosclerotic disease, but associations may vary across vascular beds.
Methods and results: A cross-sectional study of chronic kidney disease (CKD) and peripheral arterial disease (PAD) in 3089 adult participants aged 40+ from the 1999–2002 National Health and Nutrition Examination Survey (NHANES). Kidney function, assessed by estimated glomerular filtration rate (eGFR), was determined from serum creatinine and cystatin C using established equations. Peripheral arterial disease defined by an ankle brachial index <0.90.
Glomerular filtration rate estimated using cystatin C was more strongly associated with PAD compared with eGFR using serum creatinine before and after multivariable adjustment. Further, after adjustment for cystatin C, kidney function based on serum creatinine was no longer significantly associated with PAD.
However, cystatin C remained significantly associated with PAD even after adjustment for GFR estimated by serum creatinine. Compared with optimal kidney function (eGFRserum creatinine 60, eGFRcystatin C >90), the odds ratio for PAD was 3.11 (95% confidence interval 1.26–7.64) for preclinical CKD (eGFRserum creatinine 60, eGFRcystatin C <76.7) and 5.07 (3.01–8.52) for ‘confirmed’ CKD (eGFRserum creatinine <60, eGFRcystatin C <60).
Conclusion: Chronic kidney disease was strongly and independently associated with PAD. Cystatin C was a more potent marker of lower extremity PAD when compared with the serum creatinine equation currently used in clinical practice. Our results suggest that cystatin C may have clinical utility when combined with serum creatinine in evaluation of individuals who may have PAD.
Elizabeth Selvin1,2,*, Anna Köttgen1 and Josef Coresh1,2
1 Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287, USA
2 Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
Methods and results: A cross-sectional study of chronic kidney disease (CKD) and peripheral arterial disease (PAD) in 3089 adult participants aged 40+ from the 1999–2002 National Health and Nutrition Examination Survey (NHANES). Kidney function, assessed by estimated glomerular filtration rate (eGFR), was determined from serum creatinine and cystatin C using established equations. Peripheral arterial disease defined by an ankle brachial index <0.90.
Glomerular filtration rate estimated using cystatin C was more strongly associated with PAD compared with eGFR using serum creatinine before and after multivariable adjustment. Further, after adjustment for cystatin C, kidney function based on serum creatinine was no longer significantly associated with PAD.
However, cystatin C remained significantly associated with PAD even after adjustment for GFR estimated by serum creatinine. Compared with optimal kidney function (eGFRserum creatinine 60, eGFRcystatin C >90), the odds ratio for PAD was 3.11 (95% confidence interval 1.26–7.64) for preclinical CKD (eGFRserum creatinine 60, eGFRcystatin C <76.7) and 5.07 (3.01–8.52) for ‘confirmed’ CKD (eGFRserum creatinine <60, eGFRcystatin C <60).
Conclusion: Chronic kidney disease was strongly and independently associated with PAD. Cystatin C was a more potent marker of lower extremity PAD when compared with the serum creatinine equation currently used in clinical practice. Our results suggest that cystatin C may have clinical utility when combined with serum creatinine in evaluation of individuals who may have PAD.
Elizabeth Selvin1,2,*, Anna Köttgen1 and Josef Coresh1,2
1 Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287, USA
2 Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
Wednesday
Kidney Function Decline Increases Risk Of Heart Failure And Premature Death
ScienceDaily (Nov. 9, 2009) — cystatin C Research: Declining kidney function is linked to a higher risk of heart failure, heart attack, peripheral arterial disease, and early death in individuals with or without kidney disease, according to a pair of studies appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN).
The findings indicate that poor kidney function may raise an individual's risk for cardiovascular complications. To evaluate heart health, clinicians should factor in not only their patients' current level of kidney function, but also changes in kidney function over time.
Chronic kidney disease (CKD) patients have an increased risk of developing and dying from cardiovascular disease, but the links between kidney function and heart health are not well understood. Michael Shlipak, MD (San Francisco VA Medical Center and University of California, San Francisco), Mark Sarnak, MD (Tufts-New England Medical Center), and their colleagues studied clinical information from individuals who were enrolled in the Cardiovascular Health Study, a community-based study of elderly people.
Using a new blood test of kidney function, called cystatin C , the researchers looked for links between changes in kidney function during a period of seven years with the incidence of heart failure, heart attack, stroke, and peripheral arterial disease (obstruction of large arteries in the arms and legs) during the subsequent eight years. Among 4,378 eligible participants in the study, those with rapid kidney decline (1,083 patients) demonstrated a 32% increased risk of experiencing heart failure, a 48% increased risk of having a heart attack, and a 67% increased risk of developing peripheral arterial disease. (They did not have an increased risk of suffering a stroke.)
Importantly, researchers identified an association between rapid kidney function decline and heart complications in patients with and without CKD. Treatments that slow the decline of kidney function and stabilize it in the normal range, before kidney disease develops, could have substantial health benefits.
In the second study, Kunihiro Matsushita, MD, PhD, Josef Coresh, MD, PhD (Johns Hopkins University), and their colleagues examined the effects of changes in kidney function in 13,029 participants of the Atherosclerosis Risk in Communities (ARIC) Study, a population-based sample of individuals aged 45 to 64 years. The researchers followed patients from 1987 to 2006, and monitored participants' kidney function at the start of the study, three years into the study, and nine years into the study. Investigators found that a large drop in kidney function over time -- regardless of the initial level of function -- increased one's risk of developing heart disease and of dying early. Patients whose kidney function dropped by more than 5.6% per year demonstrated a 30% increased risk of developing heart disease and a 22% increased risk of dying prematurely compared to patients with stable kidney function.
Physicians regularly monitor kidney function in elderly patients and patients with diabetes and hypertension to optimize the dose of prescription drugs excreted by the kidneys. This study indicates that physicians who detect a decline in patients' kidney function over time should view this as a sign of increased risk of heart disease and premature death.
"Our results suggest there may be clinical value in sequential kidney function data, often measured in routine care, even among individuals with mildly reduced kidney function," the authors wrote.
Dr. Shlipak's and Dr. Sarnak's co-authors include Ronit Katz, DPhil, Bryan Kestenbaum, MD, David Siscovick, MD (University of Washington); Linda Fried, MD (VA Pittsburgh Healthcare System); Anne Newman, MD (University of Pittsburgh); and Dena Rifkin, MD (Tufts-New England Medical Center). Dr. Matsushita's and Dr. Coresh's co-authors include Elizabeth Selvin, PhD, Lori Bash, PhD, Brad Astor, PhD (Johns Hopkins University), and Nora Franceschini, MD (University of North Carolina).
The findings indicate that poor kidney function may raise an individual's risk for cardiovascular complications. To evaluate heart health, clinicians should factor in not only their patients' current level of kidney function, but also changes in kidney function over time.
Chronic kidney disease (CKD) patients have an increased risk of developing and dying from cardiovascular disease, but the links between kidney function and heart health are not well understood. Michael Shlipak, MD (San Francisco VA Medical Center and University of California, San Francisco), Mark Sarnak, MD (Tufts-New England Medical Center), and their colleagues studied clinical information from individuals who were enrolled in the Cardiovascular Health Study, a community-based study of elderly people.
Using a new blood test of kidney function, called cystatin C , the researchers looked for links between changes in kidney function during a period of seven years with the incidence of heart failure, heart attack, stroke, and peripheral arterial disease (obstruction of large arteries in the arms and legs) during the subsequent eight years. Among 4,378 eligible participants in the study, those with rapid kidney decline (1,083 patients) demonstrated a 32% increased risk of experiencing heart failure, a 48% increased risk of having a heart attack, and a 67% increased risk of developing peripheral arterial disease. (They did not have an increased risk of suffering a stroke.)
Importantly, researchers identified an association between rapid kidney function decline and heart complications in patients with and without CKD. Treatments that slow the decline of kidney function and stabilize it in the normal range, before kidney disease develops, could have substantial health benefits.
In the second study, Kunihiro Matsushita, MD, PhD, Josef Coresh, MD, PhD (Johns Hopkins University), and their colleagues examined the effects of changes in kidney function in 13,029 participants of the Atherosclerosis Risk in Communities (ARIC) Study, a population-based sample of individuals aged 45 to 64 years. The researchers followed patients from 1987 to 2006, and monitored participants' kidney function at the start of the study, three years into the study, and nine years into the study. Investigators found that a large drop in kidney function over time -- regardless of the initial level of function -- increased one's risk of developing heart disease and of dying early. Patients whose kidney function dropped by more than 5.6% per year demonstrated a 30% increased risk of developing heart disease and a 22% increased risk of dying prematurely compared to patients with stable kidney function.
Physicians regularly monitor kidney function in elderly patients and patients with diabetes and hypertension to optimize the dose of prescription drugs excreted by the kidneys. This study indicates that physicians who detect a decline in patients' kidney function over time should view this as a sign of increased risk of heart disease and premature death.
"Our results suggest there may be clinical value in sequential kidney function data, often measured in routine care, even among individuals with mildly reduced kidney function," the authors wrote.
Dr. Shlipak's and Dr. Sarnak's co-authors include Ronit Katz, DPhil, Bryan Kestenbaum, MD, David Siscovick, MD (University of Washington); Linda Fried, MD (VA Pittsburgh Healthcare System); Anne Newman, MD (University of Pittsburgh); and Dena Rifkin, MD (Tufts-New England Medical Center). Dr. Matsushita's and Dr. Coresh's co-authors include Elizabeth Selvin, PhD, Lori Bash, PhD, Brad Astor, PhD (Johns Hopkins University), and Nora Franceschini, MD (University of North Carolina).
Thursday
cystatin C and CRP:Change of glomerular filtration rate in healthy adults with aging
AIM: In order to determine the relationship between glomerular filtration rate (GFR) and age, the associated factors, and the accurate method of GFR in healthy adults, we conducted a cross-sectional study in community-dwelling adults in Beijing.
METHODS: Renal function of 201 clinically healthy subjects was determined using technetium-99 m-labelled diethylene triamine pentacetic acid ((99m)Tc-DTPA). Estimated GFR was calculated with the Cockcroft-Gault (CG) equation, abbreviated Modification of Diet in Renal Disease (MDRD) equation, and plasma clearance of creatinine (Ccr). Serum cystatin C, biomarkers of inflammatory and endothelial cells were analyzed as well. Protein intake, carotid artery intima-media thickness and plaque formation were assayed as well.
RESULTS: Glomerular filtration rate was negatively associated with age and the correlation coefficient for (99m)Tc-GFR, CG-GFR, MDRD-GFR, Ccr were -0.643, -0.736, -0.55 and -0.619, respectively (P < 0.001), while the correlation coefficient between cystatin C and age was 0.681 (P < 0.001). Estimated GFR were associated with measured GFR, and the correlation coefficient for Ccr, CG-GFR and MDRD-GFR were 0.813, 0.582 and 0.418, respectively (P < 0.001). The area under the receiver-operator curve of Ccr was larger, CG was smaller while MDRD was the smallest, and the difference was significant (P < 0.001). So a predicted equation was presented by cystatin C and C-reactive protein for the elderly.
CONCLUSION: In the clinically healthy adults, GFR declined with age. MDRD and CG equation are not suitable to estimate GFR in healthy adults. The predicted equation established by cystatin C and C-reactive protein may be more accurate.
Sun X, Chen Y, Chen X, Wang J, Xi C, Lin S, Liu X.
Institute of Nephrology of PLA, General Hospital of PLA, Beijing, China
METHODS: Renal function of 201 clinically healthy subjects was determined using technetium-99 m-labelled diethylene triamine pentacetic acid ((99m)Tc-DTPA). Estimated GFR was calculated with the Cockcroft-Gault (CG) equation, abbreviated Modification of Diet in Renal Disease (MDRD) equation, and plasma clearance of creatinine (Ccr). Serum cystatin C, biomarkers of inflammatory and endothelial cells were analyzed as well. Protein intake, carotid artery intima-media thickness and plaque formation were assayed as well.
RESULTS: Glomerular filtration rate was negatively associated with age and the correlation coefficient for (99m)Tc-GFR, CG-GFR, MDRD-GFR, Ccr were -0.643, -0.736, -0.55 and -0.619, respectively (P < 0.001), while the correlation coefficient between cystatin C and age was 0.681 (P < 0.001). Estimated GFR were associated with measured GFR, and the correlation coefficient for Ccr, CG-GFR and MDRD-GFR were 0.813, 0.582 and 0.418, respectively (P < 0.001). The area under the receiver-operator curve of Ccr was larger, CG was smaller while MDRD was the smallest, and the difference was significant (P < 0.001). So a predicted equation was presented by cystatin C and C-reactive protein for the elderly.
CONCLUSION: In the clinically healthy adults, GFR declined with age. MDRD and CG equation are not suitable to estimate GFR in healthy adults. The predicted equation established by cystatin C and C-reactive protein may be more accurate.
Sun X, Chen Y, Chen X, Wang J, Xi C, Lin S, Liu X.
Institute of Nephrology of PLA, General Hospital of PLA, Beijing, China
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