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Combined association of albuminuria and cystatin C-based estimated GFR with mortality, coronary heart disease, and heart failure outcomes: the Atherosclerosis Risk in Communities (ARIC) Study.

TitleCombined association of albuminuria and cystatin C-based estimated GFR with mortality, coronary heart disease, and heart failure outcomes: the Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2012
AuthorsWaheed S, Matsushita K, Sang Y, Hoogeveen RC, Ballantyne CM, Coresh JJ
Secondary AuthorsAstor BC
JournalAm J Kidney Dis
Volume60
Issue2
Pagination207-16
Date Published2012 Aug
ISSN1523-6838
KeywordsAlbuminuria, Coronary Disease, Cystatin C, Female, Glomerular Filtration Rate, Heart Failure, Humans, Incidence, Male, Middle Aged, Prospective Studies, Risk Assessment
Abstract

BACKGROUND: Serum cystatin C level has been shown to have a stronger association with clinical outcomes than serum creatinine level. However, little is known about the combined association of cystatin C-based estimated glomerular filtration rate (eGFR(cys)) and albuminuria with clinical outcomes, particularly at levels lower than current chronic kidney disease (CKD) cutoffs.

STUDY DESIGN: Prospective cohort.

SETTING & PARTICIPANTS: 10,403 ARIC (Atherosclerosis Risk in Communities) Study participants followed up for a median of 10.2 years.

PREDICTOR: eGFR(cys), albuminuria.

OUTCOMES: Mortality, coronary heart disease (CHD), and heart failure, as well as a composite of any of these separate outcomes.

RESULTS: Both decreased eGFR(cys) and albuminuria were associated independently with the composite outcome, as well as mortality, CHD, and heart failure. Although eGFR(cys) of 75-89 mL/min/1.73 m(2) in the absence of albuminuria (albumin-creatinine ratio [ACR]

LIMITATIONS: Only one measurement of cystatin C.

CONCLUSIONS: Mildly decreased eGFR(cys) and mild albuminuria independently contributed to the risk of mortality, CHD, and heart failure. Even minimally decreased eGFR(cys) (75-89 mL/min/1.73 m(2)) is associated with increased risk in the presence of mild albuminuria. Combining the 2 markers is useful for improved risk stratification even in those without clinical CKD.

DOI10.1053/j.ajkd.2012.03.011
Alternate JournalAm J Kidney Dis
PubMed ID22537422
PubMed Central IDPMC3582350
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100005C / / PHS HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100009C / / PHS HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
T32 HL007024 / HL / NHLBI NIH HHS / United States
HSN268201100006C / / PHS HHS / United States
HHSN268201100010C / / PHS HHS / United States
T32 HL007024-24S1 / HL / NHLBI NIH HHS / United States
R01 DK076770-01 / DK / NIDDK NIH HHS / United States
HHSN268201100008C / / PHS HHS / United States
HHSN268201100012C / / PHS HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
5T32HL007024 / HL / NHLBI NIH HHS / United States
R01 DK076770 / DK / NIDDK NIH HHS / United States
HHSN268201100007C / / PHS HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / / PHS HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States