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.
Publisher Copyright:
© 2018 Husain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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 -