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Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study
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. Pr...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961921/ https://www.ncbi.nlm.nih.gov/pubmed/31940363 http://dx.doi.org/10.1371/journal.pone.0226509 |
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author | Willey, Joshua Z. Moon, Yeseon Park Husain, S. Ali Elkind, Mitchell S. V. Sacco, Ralph L. Wolf, Myles Cheung, Ken Wright, Clinton B. Mohan, Sumit |
author_facet | Willey, Joshua Z. Moon, Yeseon Park Husain, S. Ali Elkind, Mitchell S. V. Sacco, Ralph L. Wolf, Myles Cheung, Ken Wright, Clinton B. Mohan, Sumit |
author_sort | Willey, Joshua Z. |
collection | PubMed |
description | 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/1.73m(2)) was higher than eGFRcys (51.72±17.2 ml/min/1.73m(2)). 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. |
format | Online Article Text |
id | pubmed-6961921 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-69619212020-01-26 Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study Willey, Joshua Z. Moon, Yeseon Park Husain, S. Ali Elkind, Mitchell S. V. Sacco, Ralph L. Wolf, Myles Cheung, Ken Wright, Clinton B. Mohan, Sumit PLoS One Research Article 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/1.73m(2)) was higher than eGFRcys (51.72±17.2 ml/min/1.73m(2)). 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. Public Library of Science 2020-01-15 /pmc/articles/PMC6961921/ /pubmed/31940363 http://dx.doi.org/10.1371/journal.pone.0226509 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Willey, Joshua Z. Moon, Yeseon Park Husain, S. Ali Elkind, Mitchell S. V. Sacco, Ralph L. Wolf, Myles Cheung, Ken Wright, Clinton B. Mohan, Sumit Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study |
title | Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study |
title_full | Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study |
title_fullStr | Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study |
title_full_unstemmed | Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study |
title_short | Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study |
title_sort | creatinine versus cystatin c for renal function-based mortality prediction in an elderly cohort: the northern manhattan study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961921/ https://www.ncbi.nlm.nih.gov/pubmed/31940363 http://dx.doi.org/10.1371/journal.pone.0226509 |
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