Cystatin C and albuminuria as risk factors for development of CKD stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA).

Abstract

BACKGROUND:

The growing burden and morbidity of chronic kidney disease (CKD) warrant effective strategies for identifying those at increased risk. We examined the association of cystatin C level and albuminuria with the development of CKD stage 3.

STUDY DESIGN:

Prospective observational study.

SETTING & PARTICIPANTS:

5,422 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2).

PREDICTOR:

Participants were categorized into 4 mutually exclusive groups: the presence or absence of microalbuminuria (albumin-creatinine ratio >17 and >25 μg/mg in men and women, respectively) in those with or without cystatin C level ≥1.0 mg/L.

OUTCOMES & MEASUREMENTS:

Incident CKD stage 3 was defined as eGFR <60 mL/min/1.73 m(2) at the third or fourth visit and an annual decrease >1 mL/min/1.73 m(2). Poisson regression was used to evaluate incident rate ratios in unadjusted and adjusted analyses that include baseline eGFR.

RESULTS:

Mean age was 61 years, 49% were men, 38% were white, 11% had diabetes, 13.7% had cystatin C level ≥1 mg/L, 8.4% had microalbuminuria, and 2.7% had cystatin C level ≥1 mg/L with microalbuminuria. 554 (10%) participants developed CKD stage 3 during a median follow-up of 4.7 years, and adjusted incidence rate ratios were 1.57 (95% CI, 1.19-2.07), 1.37 (95% CI, 1.13-1.66), and 2.12 (95% CI, 1.61-2.80) in those with microalbuminuria, cystatin C level ≥1 mg/L, and both, respectively, compared with those with neither.

LIMITATIONS:

Relatively short follow-up and absence of measured GFR.

CONCLUSIONS:

Cystatin C level and microalbuminuria are independent risk factors for incident CKD stage 3 and could be useful as screening tools to identify those at increased risk.

• Authors: Shani Shastri, Ronit Katz, Michael G Shlipak, Bryan Kestenbaum, Carmen A Peralta, Holly Kramer, David R Jacobs Jr, Ian H de Boer, Mary Cushman, David Siscovick, Mark J Sarnak
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 57 Issue 6 Pg. 832-40 (Jun 2011) ISSN: 1523-6838 [Electronic] United States
• PMID: 21296473 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Cystatin C

Topics

• Aged
• Aged, 80 and over
• Albuminuria (blood, complications, ethnology)
• Biomarkers (blood)
• Cystatin C (blood)
• Disease Progression
• Ethnicity
• Female
• Follow-Up Studies
• Glomerular Filtration Rate (physiology)
• Humans
• Kidney Failure, Chronic (blood, ethnology, etiology)
• Male
• Middle Aged
• Nephelometry and Turbidimetry
• Prognosis
• Retrospective Studies
• Risk Factors