TY - JOUR
T1 - Comparison of measured GFR, serum creatinine, cystatin C, and beta-trace protein to predict ESRD in African Americans with hypertensive CKD
AU - Bhavsar, Nrupen A.
AU - Appel, Lawrence J.
AU - Kusek, John W.
AU - Contreras, Gabriel
AU - Bakris, George
AU - Coresh, Josef
AU - Astor, Brad C.
N1 - Funding Information:
Support: This study was supported by cooperative agreements from NIDDK and other grants from the National Institutes of Health (NIH): M01-RR00080 , 5M01 RR00071 , M01 00032 , P20-RR11145 , M01 RR00827 , M01 RR00052 , 2P20 R11104 , and DK 2818-02 . In addition, we gratefully acknowledge support from the Office of Research in Minority Health and the donation of drug and financial support from Pfizer Inc, AstraZeneca Pharmaceuticals, and King Pharmaceuticals Inc. The cystatin C and BTP assays were funded by the CKD Epidemiology Collaboration (CKD-EPI) through grants UO1 NIDDK 053869 , UO1 NIDDK 067651 , and UO1 NIDDK 35073 . Dr Astor was supported in part by grant R21DK078218 from the NIDDK . Dr Bhavsar was supported by the NIH/National Heart, Lung, and Blood Institute grant T32HL07024 .
PY - 2011/12
Y1 - 2011/12
N2 - Background: Identification of persons with chronic kidney disease (CKD) who are at highest risk to progress to end-stage renal disease (ESRD) is necessary to reduce the burden of kidney failure. The relative utility of traditional markers of kidney function, including estimated glomerular filtration rate (eGFR) and serum creatinine level, and emerging markers of kidney function, including cystatin C and beta-trace protein (BTP) levels, to predict ESRD and mortality has yet to be established. Study Design: Randomized clinical trial followed by an observational cohort study. Setting & Participants: 865 African American individuals with hypertensive CKD enrolled in a clinical trial of 2 levels of blood pressure control and 3 different antihypertensive drugs as initial therapy and subsequently followed by an observational cohort study. Predictors: Quintile of measured GFR (mGFR) by iothalamate clearance, serum creatinine, serum creatininebased eGFR, cystatin C, and BTP values. Outcomes & Measurements: Incidence of ESRD and mortality. Results: 246 participants reached ESRD during a median follow-up of 102 months. The incidence rate of ESRD was higher with higher quintiles of each marker. The association between higher BTP level and ESRD was stronger than those for the other markers, including mGFR. All markers remained significantly associated with ESRD after adjustment for mGFR and relevant covariates (all P < 0.05), with BTP level retaining the strongest association (HR for highest vs lowest quintile, 5.7; 95% CI, 2.2-14.9). Associations with the combined end point of ESRD or mortality (n = 390) were weaker, but remained significant for cystatin C (P = 0.05) and BTP levels (P = 0.004). Limitations: The ability of these markers to predict ESRD and mortality in other racial and ethnic groups and in individuals with CKD due to other causes is unknown. Conclusions: Plasma BTP and cystatin C levels may be useful adjuncts to serum creatinine level and mGFR in evaluating risk of progression of kidney disease.
AB - Background: Identification of persons with chronic kidney disease (CKD) who are at highest risk to progress to end-stage renal disease (ESRD) is necessary to reduce the burden of kidney failure. The relative utility of traditional markers of kidney function, including estimated glomerular filtration rate (eGFR) and serum creatinine level, and emerging markers of kidney function, including cystatin C and beta-trace protein (BTP) levels, to predict ESRD and mortality has yet to be established. Study Design: Randomized clinical trial followed by an observational cohort study. Setting & Participants: 865 African American individuals with hypertensive CKD enrolled in a clinical trial of 2 levels of blood pressure control and 3 different antihypertensive drugs as initial therapy and subsequently followed by an observational cohort study. Predictors: Quintile of measured GFR (mGFR) by iothalamate clearance, serum creatinine, serum creatininebased eGFR, cystatin C, and BTP values. Outcomes & Measurements: Incidence of ESRD and mortality. Results: 246 participants reached ESRD during a median follow-up of 102 months. The incidence rate of ESRD was higher with higher quintiles of each marker. The association between higher BTP level and ESRD was stronger than those for the other markers, including mGFR. All markers remained significantly associated with ESRD after adjustment for mGFR and relevant covariates (all P < 0.05), with BTP level retaining the strongest association (HR for highest vs lowest quintile, 5.7; 95% CI, 2.2-14.9). Associations with the combined end point of ESRD or mortality (n = 390) were weaker, but remained significant for cystatin C (P = 0.05) and BTP levels (P = 0.004). Limitations: The ability of these markers to predict ESRD and mortality in other racial and ethnic groups and in individuals with CKD due to other causes is unknown. Conclusions: Plasma BTP and cystatin C levels may be useful adjuncts to serum creatinine level and mGFR in evaluating risk of progression of kidney disease.
KW - End-stage renal disease
KW - beta trace protein
KW - cystatin C
KW - iothalamate glomerular filtration rate
KW - serum creatinine
UR - http://www.scopus.com/inward/record.url?scp=81755174330&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=81755174330&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2011.07.018
DO - 10.1053/j.ajkd.2011.07.018
M3 - Article
C2 - 21944667
AN - SCOPUS:81755174330
SN - 0272-6386
VL - 58
SP - 886
EP - 893
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -