The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease

Hyoungnae Kim; Jung Tak Park; Joongyub Lee; Ji Yong Jung; Kyu Beck Lee; Yeong Hoon Kim; Tae Hyun Yoo; Shin Wook Kang; Kyu Hun Choi; Kook Hwan Oh; Curie Ahn; Seung Hyeok Han

doi:10.1016/j.atherosclerosis.2021.08.036

The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease

Hyoungnae Kim, Jung Tak Park, Joongyub Lee, Ji Yong Jung, Kyu Beck Lee, Yeong Hoon Kim, Tae Hyun Yoo, Shin Wook Kang, Kyu Hun Choi, Kook Hwan Oh, Curie Ahn, Seung Hyeok Han

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Background and aims: Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). Methods: This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60–89; G3: 30–59; G4: 15–29; G5: <15 mL/min/1.73 m² without kidney replacement therapy). The difference in eGFR (eGFR_diff) was calculated by subtracting the cystatin C-based eGFR (eGFR_cys) from the creatinine-based eGFR (eGFR_creat). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death. Results: During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFR_diff tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28–3.51) than the lowest tertile when adjusted for eGFR_creat, eGFR_cys, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03–1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFR_diff was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01–1.05). Conclusions: A large positive difference between eGFR_creat and eGFR_cys was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFR_diff.

Original language	English
Pages (from-to)	53-61
Number of pages	9
Journal	Atherosclerosis
Volume	335
DOIs	https://doi.org/10.1016/j.atherosclerosis.2021.08.036
Publication status	Published - 2021 Oct

Bibliographical note

Funding Information:
This work was supported by the Research Program funded by the Korea Disease Control and Prevention Agency ( 2011E3300300 , 2012E3301100 , 2013E3301600 , 2013E3301601 , 2013E3301602 , 2016E3300200 , 2016E3300201 , 2016E3300202 , 2019E320100 , 2019E320101 , and 2019E320102 ) and Soonchunhyang University Research Fund. Sponsors were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Publisher Copyright:
© 2021 Elsevier B.V.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.atherosclerosis.2021.08.036

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Kim, H., Park, J. T., Lee, J., Jung, J. Y., Lee, K. B., Kim, Y. H., Yoo, T. H., Kang, S. W., Choi, K. H., Oh, K. H., Ahn, C., & Han, S. H. (2021). The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease. Atherosclerosis, 335, 53-61. https://doi.org/10.1016/j.atherosclerosis.2021.08.036

@article{97d363e9b31a4e4a9e4926f292c2ed46,

title = "The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease",

abstract = "Background and aims: Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). Methods: This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60–89; G3: 30–59; G4: 15–29; G5: <15 mL/min/1.73 m2 without kidney replacement therapy). The difference in eGFR (eGFRdiff) was calculated by subtracting the cystatin C-based eGFR (eGFRcys) from the creatinine-based eGFR (eGFRcreat). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death. Results: During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFRdiff tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28–3.51) than the lowest tertile when adjusted for eGFRcreat, eGFRcys, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03–1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFRdiff was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01–1.05). Conclusions: A large positive difference between eGFRcreat and eGFRcys was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFRdiff.",

author = "Hyoungnae Kim and Park, {Jung Tak} and Joongyub Lee and Jung, {Ji Yong} and Lee, {Kyu Beck} and Kim, {Yeong Hoon} and Yoo, {Tae Hyun} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Oh, {Kook Hwan} and Curie Ahn and Han, {Seung Hyeok}",

note = "Funding Information: This work was supported by the Research Program funded by the Korea Disease Control and Prevention Agency ( 2011E3300300 , 2012E3301100 , 2013E3301600 , 2013E3301601 , 2013E3301602 , 2016E3300200 , 2016E3300201 , 2016E3300202 , 2019E320100 , 2019E320101 , and 2019E320102 ) and Soonchunhyang University Research Fund. Sponsors were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021 Elsevier B.V.",

year = "2021",

month = oct,

doi = "10.1016/j.atherosclerosis.2021.08.036",

language = "English",

volume = "335",

pages = "53--61",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease

AU - Kim, Hyoungnae

AU - Park, Jung Tak

AU - Lee, Joongyub

AU - Jung, Ji Yong

AU - Lee, Kyu Beck

AU - Kim, Yeong Hoon

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Oh, Kook Hwan

AU - Ahn, Curie

AU - Han, Seung Hyeok

N1 - Funding Information: This work was supported by the Research Program funded by the Korea Disease Control and Prevention Agency ( 2011E3300300 , 2012E3301100 , 2013E3301600 , 2013E3301601 , 2013E3301602 , 2016E3300200 , 2016E3300201 , 2016E3300202 , 2019E320100 , 2019E320101 , and 2019E320102 ) and Soonchunhyang University Research Fund. Sponsors were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: © 2021 Elsevier B.V.

PY - 2021/10

Y1 - 2021/10

N2 - Background and aims: Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). Methods: This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60–89; G3: 30–59; G4: 15–29; G5: <15 mL/min/1.73 m2 without kidney replacement therapy). The difference in eGFR (eGFRdiff) was calculated by subtracting the cystatin C-based eGFR (eGFRcys) from the creatinine-based eGFR (eGFRcreat). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death. Results: During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFRdiff tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28–3.51) than the lowest tertile when adjusted for eGFRcreat, eGFRcys, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03–1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFRdiff was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01–1.05). Conclusions: A large positive difference between eGFRcreat and eGFRcys was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFRdiff.

AB - Background and aims: Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). Methods: This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60–89; G3: 30–59; G4: 15–29; G5: <15 mL/min/1.73 m2 without kidney replacement therapy). The difference in eGFR (eGFRdiff) was calculated by subtracting the cystatin C-based eGFR (eGFRcys) from the creatinine-based eGFR (eGFRcreat). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death. Results: During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFRdiff tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28–3.51) than the lowest tertile when adjusted for eGFRcreat, eGFRcys, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03–1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFRdiff was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01–1.05). Conclusions: A large positive difference between eGFRcreat and eGFRcys was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFRdiff.

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SN - 0021-9150

VL - 335

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ER -

The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease

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UN SDGs

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