Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts : the BiomarCaRE project
Rothenbacher, Dietrich (German Cancer Research Center (DKFZ))
Rehm, Martin (Ulm University)
Iacoviello, Licia (University of Insubria (Itàlia))
Costanzo, Simona (Istituto Neurologico Mediterraneo Neuromed (Itàlia))
Tunstall-Pedoe, Hugh (University of Dundee)
Belch, Jill J.F. (University of Dundee)
Söderberg, Stefan (Umeå University)
Hultdin, Johan (Umeå University)
Salomaa, Veikko (Finnish Institute for Health and Welfare)
Jousilahti, Pekka (Finnish Institute for Health and Welfare)
Linneberg, Allan (Bispebjerg and Frederiksberg Hospitals (Copenhagen, Dinamarca))
Sans, Susana (Institut Català de la Salut)
Padró, Teresa (Institut d'Investigació Biomèdica Sant Pau)
Thorand, Barbara (German Research Center for Environmental Health)
Meisinger, C. (Chair of Epidemiology at UNIKA-T Augsburg)
Kee, Frank (Queen's University of Belfast)
McKnight, Amy Jayne (Queen's University of Belfast)
Palosaari, Tarja (Finnish Institute for Health and Welfare)
Kuulasmaa, Kari (Finnish Institute for Health and Welfare)
Waldeyer, Christoph (University Heart Center Hamburg)
Zeller, Tanja (German Center for Cardiovascular Research (DZHK e.V.))
Blankenberg, Stefan (German Center for Cardiovascular Research (DZHK e.V.))
Koenig, Wolfgang (DZHK (German Centre for Cardiovascular Research))
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	Chronic kidney disease has emerged as a strong cardiovascular risk factor, and in many current guidelines, it is already considered as a coronary heart disease (CHD) equivalent. Routinely, creatinine has been used as the main marker of renal function, but recently, cystatin C emerged as a more promising marker. The aim of this study was to assess the comparative cardiovascular and mortality risk of chronic kidney disease (CKD) using cystatin C-based and creatinine-based equations of the estimated glomerular filtration rate (eGFR) in participants of population-based and disease cohorts. The present study has been conducted within the BiomarCaRE project, with harmonized data from 20 population-based cohorts (n = 76,954) from 6 European countries and 3 cardiovascular disease (CVD) cohorts (n = 4982) from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for the Systematic COronary Risk Evaluation (SCORE) variables and study center. Main outcome measures were cardiovascular diseases, cardiovascular death, and all-cause mortality. The overall prevalence of CKD stage 3-5 by creatinine- and cystatin C-based eGFR, respectively, was 3. 3% and 7. 4% in the population-based cohorts and 13. 9% and 14. 4% in the disease cohorts. CKD was an important independent risk factor for subsequent CVD events and mortality. For example, in the population-based cohorts, the HR for CVD mortality was 1. 72 (95% CI 1. 53 to 1. 92) with creatinine-based CKD and it was 2. 14 (95% CI 1. 90 to 2. 40) based on cystatin-based CKD compared to participants without CKD. In general, the HRs were higher for cystatin C-based CKD compared to creatinine-based CKD, for all three outcomes and risk increased clearly below the conventional threshold for CKD, also in older adults. Net reclassification indices were larger for a cystatin-C based CKD definition. Differences in HRs (between the two CKD measures) in the disease cohorts were less pronounced than in the population-based cohorts. CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of creatinine- and cystatin C-based CKD differed considerably between low- and high-risk populations. Especially in low-risk settings, the use of cystatin C-based CKD may result in more accurate risk estimates and have better prognostic value.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Adverse outcome ; Chronic kidney disease ; Cohort study ; Creatinine ; Cystatin C ; Estimated glomerular filtration rate
Publicado en:	BMC Medicine, Vol. 18 Núm. 1 (december 2020) , p. 300, ISSN 1741-7015

DOI: 10.1186/s12916-020-01776-7
PMID: 33161898

13 p, 1.4 MB

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