Creatinine-versus cystatin C-based renal function assessment in the Northern Manhattan Study

S. Ali Husain, Joshua Z. Willey, Yeseon Park Moon, Mitchell S.V. Elkind, Ralph L. Sacco, Myles Wolf, Ken Cheung, Clinton B. Wright, Sumit Mohan

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Accurate glomerular filtration rate estimation informs drug dosing and risk stratification. Body composition heterogeneity influences creatinine production and the precision of creatinine-based estimated glomerular filtration rate (eGFR cr ) in the elderly. We compared chronic kidney disease (CKD) categorization using eGFR cr and cystatin C-based estimated GFR (eGFR cys ) in an elderly, racially/ethnically diverse cohort to determine their concordance. Methods: The Northern Manhattan Study (NOMAS) is a predominantly elderly, multi-ethnic cohort with a primary aim to study cardiovascular disease epidemiology. We included participants with concurrently measured creatinine and cystatin C. eGFR cr was calculated using the CKD-EPI2009 equation. eGFR cys was calculated using the CKD-EPI 2012 equation. Logistic regression was used to estimate odds ratios and 95% confidence intervals of factors associated with reclassification from eGFR cr ≥60ml/min/1.73m 2 to eGFR cys <60ml/min/1.73m 2 . Results: Participants (n = 2988, mean age 69±10yrs) were predominantly Hispanic, female, and overweight/obese. eGFR cys was lower than eGFR cr by mean 23mL/min/1.73m 2 .51% of participants' CKD status was discordant, and only 28% maintained the same CKD stage by both measures. Most participants (78%) had eGFR cr ≥60mL/min/1.73m 2 ; among these, 64% had eGFR cys <60mL/min/1.73m 2 . Among participants with eGFR cr ≥60mL/min/1.73m 2 , eGFR cys -based reclassification was more likely in those with age >65 years, obesity, current smoking, white race, and female sex. Conclusions: In a large, multiethnic, elderly cohort, we found a highly discrepant prevalence of CKD with eGFR cys versus eGFR cr . Determining the optimal method to estimate GFR in elderly populations needs urgent further study to improve risk stratification and drug dosing.

Original languageEnglish (US)
Article numbere0206839
JournalPloS one
Volume13
Issue number11
DOIs
StatePublished - Nov 2018

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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