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1.
Medicine (Baltimore) ; 99(32): e21551, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769895

RESUMO

To explore the association between serum cystatin C (Cys-C) and renal damage in patients with chronic hepatitis B.We retrospectively analyzed the clinical data of 425 patients with chronic hepatitis B virus (HBV) infection. Liver stiffness measured by FibroScan was used to diagnosis liver fibrosis. Cys-C levels were detected via latex-enhanced immunoturbidimetric assay.A total of 425 patients were enrolled. Among them, 217 were patients with CHB with an eGFR > 90 mL/min/1.73 m and 208 with an eGFR ≤90 mL/min/1.73 m. Cys-C levels significantly differed in patients with eGFR > 90 mL/min/1.73 m compared with patients with eGFR ≤90 mL/min/1.73 m (0.81 ±â€Š0.05 vs 1.05 ±â€Š0.06 mg/L, P < .001). Moreover, the Cys-C levels were 0.82 ±â€Š0.04 mg/L in patients without liver fibrosis, 0.98 ±â€Š0.05 mg/L in patients with mild liver fibrosis, 1.05 ±â€Š0.08 mg/L in patients with advanced liver fibrosis, and 1.12 ±â€Š0.07 mg/L in patients with liver cirrhosis (P < .001). Multivariate analyses were conducted to explore the independent factors associated with a decreased eGFR. Multivariate analysis suggested that T2DM (P = .032), liver fibrosis (P = .013), and Cys-C level (P = .035) were the independent factors associated with the decreased eGFR in patients with CHB. While age (P = .020) and Cys-C level (P = .001) were the independent factors associated with the decreased eGFR in patients with CHB-related fibrosis.The fibrosis group had significantly higher Cys-C levels than those without fibrosis. Routine monitoring of Cys-C levels is of positive significance in preventing the development of renal impairment of CHB patients.


Assuntos
Cistatina C/sangue , Vírus da Hepatite B , Hepatite B Crônica/sangue , Insuficiência Renal/sangue , Adulto , Feminino , Taxa de Filtração Glomerular , Hepatite B Crônica/complicações , Hepatite B Crônica/virologia , Humanos , Rim/virologia , Cirrose Hepática/sangue , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/virologia , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 99(28): e20060, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664054

RESUMO

OBJECTIVE: This study was designed to investigate the effects of leukocyte Rho kinase activity and serum Cystatin C (Cys C) on cardiovascular events in patients with acute coronary syndrome (ACS). METHODS: A total of 48 patients with ST-segment elevation myocardial infarction (STEMI), 23 patients with non-ST-segment elevation myocardial infarction (NSTEMI), 25 patients with unstable angina (UA) and 20 patients with no-acute coronary syndrome as control from January 2017 to June 2018 in Tianyou Hospital affiliated to Wuhan University of Science and Technology were selected in this study. Western blot was used to detect the leukocyte Rho kinase activity and Elisa kit was used to measure serum Cys C. Univariate and multivariate analysis were used to analyze the influencing factors of cardiovascular events in ACS patients. RESULTS: The activity of leukocyte Rho kinase and serum Cys C were gradually reduced in the STEMI, NSTEMI and UA patients, but all significantly higher than that in No-ASC patients, and there was a positive correlation between leukocyte Rho kinase activity and serum Cys C in ACS patients (r = 0.516, P < .001). The activity of leukocyte Rho kinase was positively correlated with the levels of serum TNF-α (r = 0.634, P < .001), IL-6 (r = 0.578, P < .001), IL-8 (r = 0.582, P < .001) in ACS patients, and the level of Cys C was positively correlated with the levels of serum TNF-α (r = 0.634, P < .001), IL-6 (r = 0.578, P < .001), IL-8 (r = 0.582, P < .001) in ACS patients. Univariate and multivariate analysis showed that the leukocyte Rho kinase activity (HR = 2.994, 95%CI = 1.328-6.054, P < .0001) and the levels of serum Cys C (HR = 1.692, 95%CI = 1.028-2.124, P < .0001) were independent influencing factors of cardiovascular events in ACS patients. CONCLUSION: The leukocyte Rho kinase activity and serum Cystatin C are high in acute coronary syndrome patients, and are the independent influencing factors of cardiovascular events in ACS patients.


Assuntos
Cistatina C/sangue , Isquemia Miocárdica/sangue , Quinases Associadas a rho/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Leucócitos/enzimologia , Masculino , Pessoa de Meia-Idade
3.
Medicine (Baltimore) ; 99(22): e20029, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481372

RESUMO

The aim of this study is to explore the potential association between cystatin C (Cys-c) and coronary heart disease (CHD) in hypertensive patients.In this study, circulating levels of Cys-c in 62 essential hypertension (EH) patients, 147 hypertension with coronary heart disease (EH + CHD) patients, and 60 healthy volunteers were investigated using immunoturbidimetry. Then, we analyzed the correlations between Cys-C and other clinical parameters.Serum Cys-C level was significantly higher in the EH and EH + CHD groups than in the control group, and higher in the EH + CHD group than in the EH group. Receiver operating characteristic curve (ROC) analysis showed that the diagnostic value of Cys-C for patients with hypertension combined CHD was 0.871(95% CI: 0.818-0.913). Serum Cys-C level was significantly higher in the double-vessel disease group and multi-vessel disease group than in the single-vessel disease group, and higher in the multi-vessel disease group than in the double-vessel disease group. Urinary albumin and CRP correlated positively with Cys-C, and HDL correlated negatively with Cys-C. Cys-C was an independent risk factor for CHD in hypertensive patients.Our results suggested that circulating Cys-C levels was up-regulated in patients with hypertension and CHD, and had correlation with the severity of coronary artery disease. As one of the important risk factors for CHD, Cys-C can predict the occurrence of CHD in patients with hypertension.


Assuntos
Doença da Artéria Coronariana/sangue , Cistatina C/sangue , Hipertensão/sangue , Idoso , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Regressão
4.
Geriatr Gerontol Int ; 20(8): 752-758, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32558258

RESUMO

AIMS: Creatinine-based estimated glomerular filtration rate (eGFRcre) has been shown to overestimate the glomerular filtration rate (GFR) when it is compared with cystatin C-based estimated GFR (eGFRcys) in older people. We investigated clinical determinants of GFR overestimation by eGFRcre and developed a score for prediction of GFR overestimation (OE) in heart failure patients. METHODS: We retrospectively examined 244 Japanese heart failure patients (aged 72.2 ± 13.1 years; 48% women) who had no known extrarenal factors that affect serum cystatin C concentration. eGFR OE by eGFRcre was defined as eGFRcre being ≥120% of cystatin C-based eGFR. RESULTS: The proportion of heart failure patients with OE was 14.3%. Patients with OE were older, had lower body weight and total skeletal muscle mass than those in patients without OE. Laboratory examinations showed that hemoglobin concentration was lower, and the ratio of blood urea nitrogen-to-creatinine was higher in patients with OE than in patients without OE. In multivariate regression analysis, body weight (<63.0 kg in men and <42.0 kg in women), hemoglobin level (<12.4 g/dL in men and <11.0 g/dL in women) and ratio of blood urea nitrogen-to-creatinine (>26.5) in addition to skeletal muscle mass were independently associated with OE. A score calculated by using cut-off levels of body weight, hemoglobin concentration and ratio of blood urea nitrogen-to-creatinine predicted OE with a sensitivity of 97.1% and a specificity of 98.1%. CONCLUSION: Overestimation of GFR by eGFRcre is predictable by a novel scoring system, which might be useful for the detection of patients who require cystatin C-based eGFR measurement for accurate assessment of renal function. Geriatr Gerontol Int 2020; 20: 752-758.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Insuficiência Cardíaca/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cistatina C/sangue , Feminino , Humanos , Japão , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Adv Gerontol ; 33(1): 121-126, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32362094

RESUMO

The purpose of the research is comparison of glomerular filtration rate calculated on the basis of serum concentrations of creatinine and cystatin C in patients with chronic heart failure and sarcopenia. In this research 86 patients with chronic heart failure and sarcopenia aged 60 to 92 years (mean age 75±7 years) were examined. GFR calculation was determined using formulas based on creatinine (CKD-EPIC), cystatin C (CKD-EPICys) in blood and both markers (CKD-EPICr-Cys). The concentration of cystatin C in blood serum was determined by the immunoturbidimetric method, and creatinine by the Jaffe kinetic method. Composite body composition was studied in all patients using dual-energy X-ray absorptiometry with calculation of the sarcopenia index (according to FNIH criteria, 2014) and measurement of total fat mass. A test with a 6-minute walk, an assessment according to the SHOKS scale (clinical condition assessment scale for CHF), transthoracic echocardiography with the measurement of EDD, ESD, LVEF, LVМ, LVIM, indicators of LV diastolic function was performed. Depending on the diagnostic criteria for sarcopenia, patients were divided into 2 groups: the first - a combination of heart failure and sarcopenia; the second - CHF without sarcopenia. In patients with CHF and sarcopenia, GFR was reassessed as calculated by the creatinine level by 23% (the absolute difference is more than 18 ml/min/1,73 m2) compared with GFR estimated by the level of cystatin C. In patients with heart failure and sarcopenia, when using a serum concentration of creatinine, there is a hypodiagnostics of the severity of chronic kidney disease. In this regard, if there are signs of sarcopenia, it is recommended to use the formula CKD-EPICys to calculate GFR.


Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Renal Crônica/diagnóstico , Sarcopenia/complicações , Sarcopenia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Humanos , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações
7.
Pediatr Blood Cancer ; 67(8): e28209, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32472983

RESUMO

BACKGROUND: Patients with high-risk neuroblastoma (HR NBL) treated with myeloablative regimens are reported to be at risk for cardiovascular morbidity, and this risk may be increased by impaired renal function. PROCEDURE: Long-term renal function was assessed in a national cohort of 18 (age 22.4 ± 4.9 years) HR NBL survivors by plasma creatinine (P-Cr), urea, and cystatin C (P-Cys C) concentrations, urine albumin/creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR). Ambulatory blood pressure was monitored, and common carotid intima-media thickness (CIMT) and left ventricular mass index (LVMI) were evaluated. RESULTS: No significant difference in P-Cr, P-Cys C, or eGFR was found between the NBL survivors and the age- and sex-matched 20 controls. P-Cys C-based eGFR (eGFRcysc) was significantly lower than the P-Cr-based eGFRcr (97 ± 17 mL/min/1.73 m2 vs 111 ± 19 mL/min/1.73 m2 , P < 0.001) among the NBL survivors. The eGFRcysc was below normal in 28%, and ACR was above normal in 22% of the NBL survivors. Abnormal blood pressure was found in 56% of the survivors, and an additional 17% were normotensive at daytime but had significant nocturnal hypertension. Both ACR and P-Cys C were associated with nighttime diastolic hypertension. CONCLUSIONS: Long-term survivors of childhood HR NBL showed signs of only mild renal dysfunction associated with diastolic hypertension. Elevated ACR and P-Cys C were the most sensitive indicators of glomerular renal dysfunction and hypertension in this patient cohort.


Assuntos
Sobreviventes de Câncer , Hipertensão , Testes de Função Renal , Neuroblastoma , Adolescente , Adulto , Creatinina/sangue , Cistatina C/sangue , Feminino , Seguimentos , Humanos , Hipertensão/sangue , Hipertensão/etiologia , Masculino , Neuroblastoma/sangue , Neuroblastoma/terapia , Ureia/sangue
8.
PLoS One ; 15(4): e0230934, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240220

RESUMO

BACKGROUND: There are still limited studies comprehensively examining the diagnostic performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in contrast-induced nephropathy (CIN). The study aimed to investigate and compare the predictive value of NGAL and cystatin C in the early diagnosis of CIN. METHODS AND MATERIALS: We searched the PubMed, EMBASE and Cochrane Library databases until November 10, 2019. The methodological quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) modeling were performed to summarize and compare the diagnostic performance of blood/urine NGAL and serum cystatin C in CIN. Subgroup and meta-regression analyses were performed according to the study and patient characteristics. RESULTS: Thirty-seven studies from thirty-one original studies were included (blood NGAL, 1840 patients in 9 studies; urine NGAL, 1701 patients in 10 studies; serum cystatin C, 5509 patients in 18 studies). Overall, serum cystatin C performed better than serum/urine NGAL (pooled DOR: 43 (95%CI: 12-152); AUROC: 0.93; λ: 3.79); serum and urine NGAL had a similar diagnostic performance (pooled DOR: 25 (95%CI: 6-108)/22(95%CI: 8-64); AUROC: 0.90/0.89; λ: 3.20/3.08). Meta-regression analysis indicated that the sources of heterogeneity might be CIN definition, assays, and nationalities. CONCLUSION: Both NGAL and cystatin C can serve as early diagnostic indicators of CIN, while cystatin C may perform better than NGAL.


Assuntos
Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Cistatina C/sangue , Gelatinases/sangue , Lipocalinas/sangue , Neutrófilos/metabolismo , Lesão Renal Aguda/metabolismo , Animais , Humanos
10.
J Nutr Health Aging ; 24(3): 277-281, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115608

RESUMO

OBJECTIVES: To clarify whether serum creatinine to cystatin C ratio (CCR), a marker of muscle mass and muscle function may be used as a simple marker of bone property. DESIGN: A cross-sectional analysis. SETTING: A general population-based observation study. PARTICIPANTS: 1,606 middle-aged to elderly (≥50 years, mean age: 66.9 ± 7.5 years old) men (n = 642) and post-menopausal women (n = 964). MEASUREMENT: Speed of sound (SOS) at the calcaneal bone was used as a surrogate marker of bone mineral density. The cross-sectional area of the muscle at the mid-thigh was measured using computed tomography. RESULTS: There was significant linear correlation between the quartiles of CCR and SOS (Q1: 1,495 ± 25, Q2: 1,499 ± 24, Q3: 1,507 ± 26, Q4: 1,511 ± 25 m/sec; P < 0.001) even in a sex-separated analysis. This association was independent of major covariates (Q1: ß = -0.126, P < 0.001; Q2: ß = -0.096, P = 0.001; Q3: ß = -0.022; P = 0.412, Q4: reference) and the mid-thigh muscle mass, while creatinine alone or eGFR did not show clear association with SOS. CONCLUSION: The CCR may be used as a simple marker of bone property independently of muscle mass in a general population with preserved renal function.


Assuntos
Densidade Óssea/fisiologia , Creatinina/sangue , Cistatina C/sangue , Idoso , Estudos Transversais , Feminino , Humanos , Masculino
11.
Am J Epidemiol ; 189(9): 942-950, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32219380

RESUMO

Few studies have comprehensively investigated the association of 2 key kidney disease measures, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR), with cancer incidence. In 8,935 participants at the baseline (1996-1998) from the Atherosclerosis Risk in Communities study, we quantified the associations of eGFR (based on creatinine and cystatin C) and ACR with cancer risk using Cox regression models adjusted for potential confounders. Due to changing guidelines for prostate cancer screening during the follow-up period, we investigated overall cancer, overall nonprostate cancer, and site-specific cancer. During a median follow-up of 14.7 years, 2,030 incident cancer cases occurred. In demographically adjusted models, low eGFR and high ACR were associated with cancer incidence (both overall and overall nonprostate cancer). These associations were attenuated after adjusting for other shared risk factors, with a significant association remaining only for ACR (≥103 compared with 5 mg/g) and overall nonprostate cancer. For site-specific cancer, only high ACR showed a significant association with lung and urinary tract cancers. Of these, the association between ACR and lung cancer appeared most robust in several sensitivity analyses. Kidney disease measures, particularly high ACR, were independently associated with cancer risk. The association between ACR and lung cancer was uniquely robust, warranting future studies to explore potential mechanisms.


Assuntos
Albuminúria/epidemiologia , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/urina , Taxa de Filtração Glomerular , Falência Renal Crônica/epidemiologia , Neoplasias/epidemiologia , Creatinina/sangue , Creatinina/urina , Cistatina C/sangue , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Fatores de Risco , Estados Unidos/epidemiologia
12.
Transplantation ; 104(7): e188-e198, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32150034

RESUMO

BACKGROUND: Cystatin C (CysC) is an early biomarker of renal dysfunction scarcely studied in patients awaiting liver transplantation (LT). Sarcopenia is frequent in cirrhosis and impacts prognosis. We aimed to assess the capability of these factors to predict survival and acute-on-chronic liver failure (ACLF) in patients awaiting LT, as well as early post-LT outcomes. METHODS: Single-center study that included all cirrhotic patients listed for LT between 2014 and 2017. Competing risk regression analysis was used to evaluate the capability of liver-, kidney-, and global status-related variables at waitlist (WL) inclusion to predict WL mortality and ACLF. Variables associated with post-LT outcomes were evaluated with logistic regression analysis. RESULTS: One-hundred-and-eighty patients were included. Fifty-six (31%) patients developed ACLF, 54 (30%) underwent LT and 35 (19%) died. In the adjusted competing risk regression analysis, CysC ≥ 1.5 mg/L, sarcopenia and MELD-Na were independent predictors of ACLF in the WL, while CysC ≥ 1.5 mg/L, sarcopenia and albumin were independent predictors of mortality. The cumulative incidence of ACLF and mortality at 12 months were 50% and 34% in patients with sarcopenia and CysC ≥1.5 mg/L. An estimated glomerular filtration rate by chronic kidney disease (CKD)-EPI-CysC-creatinine <60 mL/min/1.73 m at WL inclusion was an independent predictor of the need for renal replacement therapy (RRT) in the first month post-LT. CONCLUSIONS: Higher levels of CysC and sarcopenia are strongly associated with the ACLF and mortality in WL. The assessment of both risk factors may improve the prognostic evaluation and allow identifying a group of patients with a very high risk of poor outcomes while awaiting LT.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Cistatina C/sangue , Doença Hepática Terminal/mortalidade , Cirrose Hepática/mortalidade , Transplante de Fígado/efeitos adversos , Sarcopenia/embriologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Insuficiência Hepática Crônica Agudizada/epidemiologia , Insuficiência Hepática Crônica Agudizada/etiologia , Insuficiência Hepática Crônica Agudizada/terapia , Idoso , Biomarcadores/sangue , Creatinina/sangue , Doença Hepática Terminal/sangue , Doença Hepática Terminal/complicações , Doença Hepática Terminal/diagnóstico , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sarcopenia/sangue , Sarcopenia/etiologia , Índice de Gravidade de Doença , Listas de Espera/mortalidade
13.
Clin Chim Acta ; 505: 34-42, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32027887

RESUMO

Accurate estimation of glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Thus far, few studies in China have systematically assessed the differences among the various estimated GFR (eGFR) equations in large cohort. A total of 6287 CKD patients and 679 healthy individuals were enrolled. To estimate the GFR values in patients, MDRD, MDRD-China (MDRD-C), CKD-EPI, cystatin-C-China (CysC-C), cystatin-C-KDIGO (CysC-K), and creatinine-cystatin C-KDIGO (Cr-CysC) equations were used. The κ values between the MDRD, MDRD-C, Cr-CysC, CysC-K, and CysC-C equations and the CKD-EPI equation were 0.864, 0.914, 0.638, 0.487, and 0.388, respectively. For patients with lower-stage CKD, the GFR values from MDRD and MDRD-C equations were the highest compared with other equations, whereas the GFR values from CysC-C and CysC-K equations were the lowest. For patients with higher-stage CKD, the CKD-EPI, MDRD, MDRD-C, and Cr-CysC equations showed good consistencies among each other, whereas eGFR from CysC-C equation were higher and the CysC-C and CysC-K equations showed many obviously overestimated outliers. CKD-EPI and Cr-CysC equations were better correlated and consistent with each other in most of the CKD stages. The CKD-EPI and Cr-CysC equations may be more suitable for the comprehensive estimation of GFR in patients with CKD.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Grupo com Ancestrais do Continente Asiático , Criança , Pré-Escolar , Estudos Transversais , Progressão da Doença , Humanos , Lactente , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Caracteres Sexuais , Adulto Jovem
14.
PLoS One ; 15(2): e0228984, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097414

RESUMO

OBJECTIVE: To assess the impact of obesity, glucose tolerance, and weight loss on renal function, we measured serum creatinine and cystatin C and estimated glomerular filtration rate (GFR) indexed to 1.73m2 body surface area (BSA) and GFR indexed to actual BSA in subjects with normal and abnormal glucose tolerance before and up to 2 years after medical weight loss. METHODS: We studied 146 subjects at baseline and 3-to-6 months after 18% reduction in weight; 43 were also studied at 2-years. GFR was estimated using the MDRD, CKD-EPICr, CKD-EPICysCr, and the CKD-EPICys equations. RESULTS: eGFR was consistently lower when creatinine-based rather than cystatin C-based estimating equations were used. eGFR was lower when creatinine-based or cystatin C-based equations were indexed to 1.73m2 BSA than when they were indexed to actual BSA. eGFR indexed to actual BSA was more likely to demonstrate hyperfiltration (eGFR ≥135 ml/min) than eGFR indexed to 1.73m2 BSA and decreased into the normal range with weight loss. eGFR was highest in subjects with impaired fasting glucose but there was little difference in the patterns of change in eGFR across groups by glucose tolerance status. CONCLUSIONS: With severe obesity, high fat-free mass and BSA result in low estimates of eGFR indexed to 1.73m2 BSA, especially when creatinine-based estimating equations are used. GFR indexed to actual BSA is approximately 50% higher. When eGFR is indexed to actual BSA, many subjects display evidence of renal hyperfiltration which improves with weight loss. In subjects with severe obesity undergoing medical weight loss, estimating equations that use cystatin C and are indexed to actual BSA may provide a more accurate assessment of renal function.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Obesidade , Perda de Peso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/fisiopatologia
15.
Clin Nephrol ; 93(5): 217-226, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32101516

RESUMO

BACKGROUND: Serum creatinine has been solely used in clinical practice to identify chronic kidney disease (CKD) staging in the elderly population. Serum cystatin C is believed to more accurately define the CKD staging and is also ratified as an endogenous biomarker by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. MATERIAL AND METHODS: A total of 300 elderly Malay participants (age ≥ 65 years) with CKD, attending the Hospital University Sains Malaysia were included in the study. Demographic data and history were also recorded. Serum creatinine was assayed by Chemistry Analyzer Model Architect-C8000 (Jaffe method). While serum cystatin C was examined by Human cystatin C ELISA kit (Sigma-Aldrich) using Thermo Scientific Varioskan Flash ELISA reader. RESULTS: Out of 300 study participants, 169 (56.3%) were females. Mean age of patients was 67.6 ± 6.7 years. 64 male (64.6%) and 35 female (35.4%) patients were between 70 and 79 years. When estimated by MDRD equation, the prevalence of CKD stage 3 (defined as eGFR = 30 - 59 mL/min/1.73m2) was 27.7%, while based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 28%, 36.3%, and 36.3%, respectively. The prevalence of CKD stage 4 (defined as eGFR = 15 - 29 mL/min/1.73m2) when estimated by MDRD was 37.6%, whereas based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 36.3%, 46.4%, and 46.4%, respectively. CKD stage 5 (defined as eGFR < 15 mL/min/1.73m2) when estimated by the MDRD equation was 34.7%. While based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, the prevalence of CKD stage 5 was 35.7%, 17.3%, and 17.3%, respectively. CONCLUSION: The staging of CKD is different between the creatinine- and cystatin C-based equations. Creatinine-based equations classify patients as having CKD stage 5 twice as often as cystatin C-based equations.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Centros de Atenção Terciária
16.
Oxid Med Cell Longev ; 2020: 7098505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32047578

RESUMO

Background and Aims: Perioperative kidney injury affects 12.7% of patients undergoing lower limb revascularisation surgery. Remote ischaemic preconditioning (RIPC) is a potentially protective procedure against organ damage and consists of short nonlethal episodes of ischaemia. The main objective of this substudy was to evaluate the effect of RIPC on kidney function, inflammation, and oxidative stress in patients undergoing open surgical lower limb revascularisation. Materials and Methods. This is a subgroup analysis of a randomised, sham-controlled, double-blinded, single-centre study. A RIPC or a sham procedure was performed noninvasively along with preparation for anaesthesia in patients undergoing open surgical lower limb revascularisation. The RIPC protocol consisted of 4 cycles of 5 minutes of ischaemia, with 5 minutes of reperfusion between every episode. Blood was collected for analysis preoperatively, 2, 8, and 24 hours after surgery, and urine was collected preoperatively and 24 hours after surgery. Results: Data of 56 patients were included in the analysis. Serum creatinine, cystatin C, and beta-2 microglobulin increased, and eGFR decreased across all time points significantly more in the sham group than in the RIPC group (p = 0.021, p = 0.021, p = 0.021, p = 0.021, p = 0.021. Conclusions: Our finding of reduced release of kidney injury biomarkers may indicate the renoprotective effect of RIPC in patients undergoing open surgical lower limb revascularisation. The trial is registered with ClinicalTrials.gov NCT02689414.


Assuntos
Lesão Renal Aguda/metabolismo , Biomarcadores/metabolismo , Precondicionamento Isquêmico/métodos , Rim/patologia , Lesão Renal Aguda/patologia , Idoso , Creatinina/sangue , Cistatina C/sangue , Método Duplo-Cego , Feminino , Taxa de Filtração Glomerular , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares
17.
PLoS One ; 15(1): e0226509, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940363

RESUMO

BACKGROUND: Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of renal function. While creatinine-based eGFR (eGFRcr) is widely used in clinical practice, the use of cystatin-C to estimate GFR (eGFRcys) has demonstrated superior risk prediction in various populations. Prior studies that derived eGFR formulas have infrequently included high proportions of elderly, African-Americans, and Hispanics. OBJECTIVE: Our objective as to compare mortality risk prediction using eGFRcr and eGFRcys in an elderly, race/ethnically diverse population. DESIGN: The Northern Manhattan Study (NOMAS) is a multiethnic prospective cohort of elderly stroke-free individuals consisting of a total of 3,298 participants recruited between 1993 and 2001, with a median follow-up of 18 years. PARTICIPANTS: We included all Northern Manhattan Study (NOMAS) participants with concurrent measured creatinine and cystatin-C. MAIN MEASURES: The eGFRcr was calculated using the CKD-EPI 2009 equation. eGFRcys was calculated using the CKD-EPI 2012 equations. The performance of each eGFR formula in predicting mortality risk was tested using receiver-operating characteristics, calibration and reclassification. Net reclassification improvement (NRI) was calculated based on the Reynolds 10 year risk score from adjusted Cox models with mortality as an outcome. The primary hypothesis was that eGFRcys would better predict mortality than eGFRcr. RESULTS: Participants (n = 2988) had a mean age of 69±10.2 years and were predominantly Hispanic (53%), overweight (69%), and current or former smokers (53% combined). The mean eGFRcr (74.68±18.8 ml/min/1.73m2) was higher than eGFRcys (51.72±17.2 ml/min/1.73m2). During a mean of 13.0±5.6 years of follow-up, 53% of the cohort had died. The AUC of eGFRcys (0.73) was greater than for eGFRcr (0.67, p for difference<0.0001). The proportions of correct reclassification (NRI) based on 10 year mortality for the model with eGFRcys compared to the model with eGFRcr were 4.2% (p = 0.002). CONCLUSIONS: In an elderly, race/ethnically diverse cohort low eGFR is associated with risk of all-cause mortality. Estimated GFR based on serum cystatin-C, in comparison to serum creatinine, was a better predictor of all-cause mortality.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Testes de Função Renal , Rim/fisiologia , Mortalidade , Idoso , Área Sob a Curva , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Risco
18.
Yakugaku Zasshi ; 140(1): 81-90, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-31902889

RESUMO

We previously reported the association of the estimated glomerular filtration rate (eGFRcreat) calculated from the serum creatinine level (S-Cr) measured using the Jaffe method with the GFR (eGFRcys) estimated from the serum cystatin C level (CysC). However, few studies have compared the eGFRcreat using the enzymatic method with the eGFRcys. It is unclear whether there are differences in the results of renal function assessment. The purpose of this study was to compare the eGFRcreat calculated from the S-Cr with the eGFRcys calculated from the CysC in patients in whom the S-Cr and CysC were simultaneously measured using the enzymatic method, examine the correlations of respective parameters, and clarify physiological factors involved in differences among the parameters. The subjects were 1334 patients treated in 5 institutions. The mean values and correlation coefficient were statistically analyzed using Student's t-test and Pearson's test, respectively. Influential factors between formulae were analyzed using multiple regression analysis. The mean eGFRcreat was 67.0 mL/min/1.73 m2, being significantly higher than the mean eGFRcys (63.2). Multiple regression analysis showed that factors influencing differences in the S-Cr and CysC included the sex, age, serum albumin, and blood urea nitrogen BUN/S-Cr. Furthermore, factors involved in the overestimation of the eGFRcreat in comparison with the eGFRcys included the serum albumin and BUN/S-Cr. The differences between the eGFRcreat calculated from the S-Cr and eGFRcys were less marked than when adopting the Jaffe method in our previous study. However, the eGFRcreat were higher than the eGFRcys in patients with malnutrition or dehydration.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Ensaios Enzimáticos/métodos , Testes de Função Renal/métodos , Insuficiência Renal Crônica/diagnóstico , Biomarcadores/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Taxa de Depuração Metabólica
19.
Circ Heart Fail ; 13(1): e006326, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31959016

RESUMO

BACKGROUND: Estimated glomerular filtration rate (eGFR) based on serum creatinine (sCr) improves early after left ventricular assist device (LVAD) implantation but subsequently declines. Although sCr is a commonly accepted clinical standard, cystatin C (CysC) has shown superiority in assessment of renal function in disease states characterized by muscle wasting. Among patients with an LVAD, we aimed to (1) longitudinally compare CysC-eGFR and sCr-eGFR, (2) assess their predictive value for early postoperative outcomes, and (3) investigate mechanisms which might explain potential discrepancies. METHODS: A prospective cohort (n=116) with CysC and sCr concurrently measured at serial time points, and a retrospective cohort (n=91) with chest computed tomography performed within 40 days post-LVAD were studied. In the prospective cohort, the primary end point was a composite of in-hospital mortality, renal replacement therapy, or severe right ventricular failure. In the retrospective cohort, muscle mass was estimated using pectoralis muscle area indexed to body surface area (pectoralis muscle index). RESULTS: In the prospective cohort, sCr-eGFR significantly improved early post-LVAD and subsequently declined, whereas CysC-eGFR remained stable. CysC-eGFR but not sCr-eGFR predicted the primary end point: odds ratio per 5 mL/(min·1.73 m2) decrease 1.16 (1.02-1.31) versus 0.99 (0.94-1.05). In retrospective cohort, for every 5 days post-LVAD, a 6% decrease in pectoralis muscle index was observed (95% CI, 2%-9%, P=0.003). After adjusting for time on LVAD, for every 1 cm2/m2 decrease in pectoralis muscle index, there was a 4% decrease in 30-day post-LVAD sCr (95% CI, 1%-6%, P=0.004). CONCLUSIONS: Initial improvement in sCr-eGFR is likely due to muscle wasting following LVAD surgery. CysC may improve assessment of renal function and prediction of early postoperative outcomes in patients with an LVAD.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos
20.
Sci Rep ; 10(1): 1260, 2020 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988356

RESUMO

To investigate the association of the sarcopenia index (SI, serum creatinine value/cystatin C value × 100) with 3-year mortality and readmission among older inpatients, we reanalyzed a prospective study in the geriatric ward of a teaching hospital in western China. Older inpatients aged ≥ 60 years with normal kidney function were included. Survival status and readmission information were assessed annually during the 3-year follow-up. We applied Cox regression models to calculate the hazard ratio (HR) and 95% confidence intervals (CIs) of sarcopenia for predicting mortality and readmission. We included 248 participants (mean age: 81.2 ± 6.6 years). During the follow-up, 57 participants (23.9%) died, whereas 179 participants (75.2%) were readmitted at least one time. The SI was positively correlated with body mass index (BMI) (r = 0.214, p = 0.001), calf circumference (CC) (r = 0.253, p < 0.001), handgrip strength (r = 0.244, p < 0.001), and gait speed (r = 0.221, p < 0.001). A higher SI was independently associated with a lower risk of 3-year all-cause mortality after adjusting for potential confounders (HR per 1-SD = 0.80, 95% CI: 0.63-0.97). The SI was not significantly associated with readmission (HR per 1-SD = 0.97, 95% CI: 0.77-1.25). In conclusion, the SI is associated with 3-year all-cause mortality but not readmission in a study population of hospitalized older patients.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Sarcopenia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , China/epidemiologia , Creatinina/análise , Cistatina C/análise , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Sarcopenia/sangue , Sarcopenia/fisiopatologia
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