| Title: | Discordance between Cystatin C-Based and Creatinine-Based Estimated Glomerular Filtration Rate and Mortality in the General Population |
| Journal: | Clinical Chemistry |
| Published: | 4 Jun 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/40464748/ |
| DOI: | https://doi.org/10.1093/clinchem/hvaf063 |
| URL: | https://academic.oup.com/clinchem/advance-article-pdf/doi/10.1093/clinchem/hvaf063/63435440/hvaf063.pdf |
Publication 15078
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Abstract
BACKGROUND: The consequences for health outcomes of the discordance in cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates are gaining attention. However, the association of discordance with all-cause mortality in the general population has not been explored.</p>
METHODS: A total of 325 356 UK Biobank participants, 40 to 69 years of age, were followed for a median of 13.7 years. eGFR was calculated using both the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009/2012 equations and the European Kidney Function Consortium (EKFC) equations. Differences were expressed as the absolute difference (eGFRcys - eGFRcr, where discordance was defined as ±15 mL/min/1.73 m2 difference) and relative difference (eGFRcys/eGFRcr, where discordance was defined as eGFRcys < 60% eGFRcr). Hazard ratios (HRs) for mortality were estimated using multivariable Cox proportional hazards models.</p>
RESULTS: Among the participants, 15.5% had a discordant lower absolute eGFRcys, and 8.5% had a discordant higher absolute eGFRcys. Participants with discordant lower absolute eGFRcys (both CKD-EPI and EKFC equations) were older, more frequently male, had higher body mass index (BMI) and blood pressure, more comorbidities, and did less physical activity. A total of 26 465 deaths occurred. Participants with discordant lower eGFRcys had a 53% higher risk of mortality (HR = 1.53: 95% CI, 1.48-1.57), while those with discordant higher eGFRcys had a 30% lower risk (HR = 0.70: 95% CI, 0.66-0.75) compared to those with concordant eGFR. Those with discordance of lower relative eGFRcys had doubled risk of mortality (HR = 2.25: 95% CI, 2.04-2.47).</p>
CONCLUSIONS: eGFR discordance was prevalent and associated with mortality in general populations. These results support broader use of cystatin C for risk stratification of mortality.</p>
13 Keywords
- Adult
- Aged
- Creatinine
- Cystatin C
- Female
- Glomerular Filtration Rate
- Humans
- Male
- Middle Aged
- Mortality
- Proportional Hazards Models
- Renal Insufficiency, Chronic
- United Kingdom
8 Authors
- Qiaoling Liu
- Carlos Celis-Morales
- Jennifer S Lees
- Naveed Sattar
- Frederick K Ho
- Jill P Pell
- Patrick B Mark
- Paul Welsh
1 Application
| Application ID | Title |
|---|---|
| 71392 | Investigating complex relationships between genetics, exposures, biomarkers, endophenotypes and cardiometabolic, inflammatory, immune and brain-related health outcomes |
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