TY - JOUR
T1 - Novel markers of kidney function as predictors of ESRD, cardiovascular disease, and mortality in the general population
AU - Astor, Brad C.
AU - Shafi, Tariq
AU - Hoogeveen, Ron C.
AU - Matsushita, Kunihiro
AU - Ballantyne, Christie M.
AU - Inker, Lesley A.
AU - Coresh, Josef
N1 - Funding Information:
Support: The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. Drs Astor and Coresh are supported by the National Institute of Diabetes and Digestive and Kidney Diseases ( 1 R01 DK076770-01 ). Siemens Healthcare Diagnostics provided the reagents and loan of a BNII instrument to conduct the hs-CRP, B2M, and BTP assays. The study sponsors had no other role in the study design; collection, analysis, and interpretation of data; or writing of the report or the decision to submit the paper for publication.
PY - 2012/5
Y1 - 2012/5
N2 - Background: Cystatin C level predicts mortality more strongly than serum creatinine level. It is unknown whether this advantage extends to other outcomes, such as kidney failure, or whether other novel renal filtration markers share this advantage in predicting outcomes. Study Design: Observational cohort study. Setting & Participants: 9,988 participants in the Atherosclerosis Risk in Communities (ARIC) Study, a population-based study in 4 US communities, followed for approximately 10 years. Predictors: Serum creatinine-based estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (eGFR CKD-EPI) and cystatin C, β-trace protein (BTP), and β 2-microglobulin (B2M) levels. Outcomes: Mortality, coronary heart disease, heart failure, and kidney failure. Results: Higher cystatin C and B2M concentrations were associated more strongly with mortality (n = 1,425) than BTP level and all were associated more strongly than eGFR CKD-EPI (adjusted HR for the upper 6.7 percentile compared with the lowest quintile: 1.6 [95% CI, 1.3-1.9] for eGFR CKD-EPI, 2.9 [95% CI, 2.3-3.6] for cystatin C level, 1.9 [95% CI, 1.5-2.4] for BTP level, and 3.0 [95% CI, 2.4-3.8] for B2M level). Similar patterns were observed for coronary heart disease (n = 1,279), heart failure (n = 803), and kidney failure (n = 130). The addition of cystatin C, BTP, and B2M levels to models including eGFR CKD-EPI and all covariates, including urinary albumin-creatinine ratio, significantly improved risk prediction for all outcomes (P < 0.001). Limitations: No direct measurement of GFR. Conclusions: B2M and, to a lesser extent, BTP levels share cystatin C's advantage over eGFR CKD-EPI in predicting outcomes, including kidney failure. These additional markers may be helpful in improving estimation of risk associated with decreased kidney function beyond current estimates based on eGFR CKD-EPI.
AB - Background: Cystatin C level predicts mortality more strongly than serum creatinine level. It is unknown whether this advantage extends to other outcomes, such as kidney failure, or whether other novel renal filtration markers share this advantage in predicting outcomes. Study Design: Observational cohort study. Setting & Participants: 9,988 participants in the Atherosclerosis Risk in Communities (ARIC) Study, a population-based study in 4 US communities, followed for approximately 10 years. Predictors: Serum creatinine-based estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (eGFR CKD-EPI) and cystatin C, β-trace protein (BTP), and β 2-microglobulin (B2M) levels. Outcomes: Mortality, coronary heart disease, heart failure, and kidney failure. Results: Higher cystatin C and B2M concentrations were associated more strongly with mortality (n = 1,425) than BTP level and all were associated more strongly than eGFR CKD-EPI (adjusted HR for the upper 6.7 percentile compared with the lowest quintile: 1.6 [95% CI, 1.3-1.9] for eGFR CKD-EPI, 2.9 [95% CI, 2.3-3.6] for cystatin C level, 1.9 [95% CI, 1.5-2.4] for BTP level, and 3.0 [95% CI, 2.4-3.8] for B2M level). Similar patterns were observed for coronary heart disease (n = 1,279), heart failure (n = 803), and kidney failure (n = 130). The addition of cystatin C, BTP, and B2M levels to models including eGFR CKD-EPI and all covariates, including urinary albumin-creatinine ratio, significantly improved risk prediction for all outcomes (P < 0.001). Limitations: No direct measurement of GFR. Conclusions: B2M and, to a lesser extent, BTP levels share cystatin C's advantage over eGFR CKD-EPI in predicting outcomes, including kidney failure. These additional markers may be helpful in improving estimation of risk associated with decreased kidney function beyond current estimates based on eGFR CKD-EPI.
KW - Chronic kidney disease
KW - cystatin C
KW - estimated glomerular filtration rate
KW - serum creatinine
KW - β -microglobulin
KW - β-trace protein
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U2 - 10.1053/j.ajkd.2011.11.042
DO - 10.1053/j.ajkd.2011.11.042
M3 - Article
C2 - 22305758
AN - SCOPUS:84859787086
SN - 0272-6386
VL - 59
SP - 653
EP - 662
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -