Comparison of serum cystatin C, serum creatinine, measured GFR, and estimated GFR to assess the risk of kidney failure in American Indians with diabetic nephropathy.
Am J Kidney Dis
; 62(1): 33-41, 2013 Jul.
Article
in En
| MEDLINE
| ID: mdl-23347458
ABSTRACT
BACKGROUND:
We compared values of baseline serum cystatin C (SCysC), serum creatinine (SCr), and measured glomerular filtration rate (mGFR) for predicting end-stage renal disease (ESRD) in patients with type 2 diabetes and elevated albuminuria. STUDYDESIGN:
Observational longitudinal study. SETTING &PARTICIPANTS:
Pima Indians with type 2 diabetes and elevated albumin-creatinine ratio (ACR ≥30 mg/g). PREDICTORS Baseline SCysC, SCr, and mGFR. OUTCOMES & MEASUREMENTS Individuals were followed up from their first examination with diabetes and ACR ≥30 mg/g until December 2010, onset of ESRD, or death, whichever came first. Incidence rates adjusted for age and sex were computed by Mantel-Haenszel stratification. The abilities of SCysC, SCr, and mGFR values to predict ESRD were compared with receiver operating characteristic curves.RESULTS:
Of 234 Pima Indians with a mean age of 42.8 years who were followed up for a median of 10.7 (range, 0.6-21.3) years, 68 (29%) developed ESRD. The incidence of ESRD was significantly higher in patients in the lowest versus highest tertile of 1/SCysC (incidence rate ratio, 2.43; 95% CI, 1.31-4.50). By contrast, mGFR and 1/SCr had J-shaped associations with ESRD. In unadjusted analyses, 1/SCysC had the highest area under the receiver operating characteristic curve (AUROC; 0.719 ± 0.035) and mGFR had the lowest (0.585 ± 0.042; P < 0.001); the AUROC for 1/SCr was intermediate (0.672 ± 0.040; P = 0.1 and P = 0.03 vs 1/SCysC and mGFR, respectively). In analyses adjusted for age, sex, diabetes duration, height, weight, hemoglobin A1c level, and ACR, 1/SCysC had the highest AUROC (0.845 ± 0.026). Models with mGFR or 1/SCr alone had similar AUROCs (P = 0.9) and both were lower than the model with 1/SCysC alone (P = 0.02 and P = 0.03, respectively).LIMITATIONS:
The predictive values of the filtration markers are limited to the extent that their precision is based on a single measurement.CONCLUSIONS:
SCysC level was a better predictor of ESRD than mGFR or SCr level in Pima Indians with type 2 diabetes and elevated albuminuria.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Indians, North American
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Creatinine
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Diabetic Nephropathies
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Renal Insufficiency
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Cystatin C
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Glomerular Filtration Rate
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
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Female
/
Humans
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Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Am J Kidney Dis
Year:
2013
Type:
Article
Affiliation country:
United States