Cystatin C a Better Marker of Cardiovascular Risk in CKD: study

Results:

• There were 428 402 participants: median age was57 (IQR, 50-63) years and 237 173 (55.4%) were women. Among 76 629 olderparticipants, there were 9335 deaths and 5205 CVD events. Among 351 773 youngerparticipants, there were 14 776 deaths and 9328 CVD events.
• The 10-year probability of kidney failure wasless than 0.1%. Regardless of the eGFRcr, the 10-year probabilities of CVD andmortality were low when eGFRcys was greater than or equal to 60 mL/min/1.73 m2;conversely, with eGFRcys less than 60 mL/min/1.73 m2, 10-year risks were nearlydoubled in older adults and more than doubled in younger adults.
• Use of eGFRcys better discriminated CVD andmortality risk than eGFRcr.
• Across a 7.5% 10-year risk threshold for CVD,eGFRcys improved case Net Reclassification Index by 0.7% in older people and0.7% in younger people; eGFRcr did not add to CVD risk estimation.

The findings of this study suggest that eGFRcr 45 to 59mL/min/1.73 m2 includes a proportion of individuals at low risk and fails tocapture a substantial proportion of individuals at high-risk for CVD andmortality. The eGFRcys appears to be more sensitive and specific for CVD andmortality risks in mild CKD.

Reference:

Lees JS, Rutherford E, Stevens KI, et al. Assessment ofcystatin C level for risk stratification in adults with chronic kidney disease.JAMA Netw Open. Published online October 25, 2022.doi:10.1001/jamanetworkopen.2022.38300