TY - JOUR
T1 - Creatinine-versus cystatin C-based renal function assessment in the Northern Manhattan Study
AU - Husain, S. Ali
AU - Willey, Joshua Z.
AU - Moon, Yeseon Park
AU - Elkind, Mitchell S.V.
AU - Sacco, Ralph L.
AU - Wolf, Myles
AU - Cheung, Ken
AU - Wright, Clinton B.
AU - Mohan, Sumit
N1 - Funding Information:
This study was supported by the National Institutes of Health grants R01 HL111195 (Cheung/Elkind), NS K23073104 (Willey), and R01 NS029993 (Sacco/Elkind). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
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U2 - 10.1371/journal.pone.0206839
DO - 10.1371/journal.pone.0206839
M3 - Article
C2 - 30427947
AN - SCOPUS:85056645998
VL - 13
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 11
M1 - e0206839
ER -