03326nas a2200409 4500008004100000022001400041245007900055210006900134260001600203300001100219490000800230520214100238653001502379653001502394653003102409653001102440653002802451653002602479653002402505653003302529653000902562653002002571100002402591700002502615700001902640700002102659700001602680700002702696700002702723700002002750700001902770700001802789700002102807700002302828710002902851856003602880 2013 eng d a1533-440600aCystatin C versus creatinine in determining risk based on kidney function.0 aCystatin C versus creatinine in determining risk based on kidney c2013 Sep 05 a932-430 v3693 a

BACKGROUND: Adding the measurement of cystatin C to that of serum creatinine to determine the estimated glomerular filtration rate (eGFR) improves accuracy, but the effect on detection, staging, and risk classification of chronic kidney disease across diverse populations has not been determined.

METHODS: We performed a meta-analysis of 11 general-population studies (with 90,750 participants) and 5 studies of cohorts with chronic kidney disease (2960 participants) for whom standardized measurements of serum creatinine and cystatin C were available. We compared the association of the eGFR, as calculated by the measurement of creatinine or cystatin C alone or in combination with creatinine, with the rates of death (13,202 deaths in 15 cohorts), death from cardiovascular causes (3471 in 12 cohorts), and end-stage renal disease (1654 cases in 7 cohorts) and assessed improvement in reclassification with the use of cystatin C.

RESULTS: In the general-population cohorts, the prevalence of an eGFR of less than 60 ml per minute per 1.73 m(2) of body-surface area was higher with the cystatin C-based eGFR than with the creatinine-based eGFR (13.7% vs. 9.7%). Across all eGFR categories, the reclassification of the eGFR to a higher value with the measurement of cystatin C, as compared with creatinine, was associated with a reduced risk of all three study outcomes, and reclassification to a lower eGFR was associated with an increased risk. The net reclassification improvement with the measurement of cystatin C, as compared with creatinine, was 0.23 (95% confidence interval [CI], 0.18 to 0.28) for death and 0.10 (95% CI, 0.00 to 0.21) for end-stage renal disease. Results were generally similar for the five cohorts with chronic kidney disease and when both creatinine and cystatin C were used to calculate the eGFR.

CONCLUSIONS: The use of cystatin C alone or in combination with creatinine strengthens the association between the eGFR and the risks of death and end-stage renal disease across diverse populations. (Funded by the National Kidney Foundation and others.).

10aCreatinine10aCystatin C10aGlomerular Filtration Rate10aHumans10aKidney Failure, Chronic10aKidney Function Tests10aReference Standards10aRenal Insufficiency, Chronic10aRisk10aRisk Assessment1 aShlipak, Michael, G1 aMatsushita, Kunihiro1 aArnlöv, Johan1 aInker, Lesley, A1 aKatz, Ronit1 aPolkinghorne, Kevan, R1 aRothenbacher, Dietrich1 aSarnak, Mark, J1 aAstor, Brad, C1 aCoresh, Josef1 aLevey, Andrew, S1 aGansevoort, Ron, T1 aCKD Prognosis Consortium uhttps://chs-nhlbi.org/node/7377