Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate, Vascular Disease, and

Mortality in Persons With Diabetes in the U.S.

Featured Article:

Ching-Wei Tsai, Morgan E. Grams, Lesley A. Inker, Josef Coresh, and Elizabeth Selvin

Diabetes Care Volume 37: 1002-1008

April, 2014

STUDY OBJECTIVE 

• Serum cystatin C is an alternative to serum creatinine for estimating glomerular filtration rate (GFR)

• Performance of GFR estimated using cystatin C (eGFRcys) was compared with that using creatinine (eGFRcr) for the identification of reduced kidney function and its association with diabetes complications

Tsai et al. Diabetes Care 2014;37:1002-1008

STUDY DESIGN AND METHODS

• Data were analyzed from adult participants from the 1999–2002 National Health and Nutrition Examination Survey with available cystatin C

• Kidney function was dichotomized as preserved or reduced using the 2012 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C and the 2009 CKD-EPI creatinine equations

Tsai et al. Diabetes Care 2014;37:1002-1008

RESULTS

• Among 778 diabetes patients, the prevalence of reduced kidney function was 16.5% using eGFRcr and 22.0% using eGFRcys

• More people with diabetes were reclassified from preserved kidney function by eGFRcr to reduced kidney function by eGFRcys than people without diabetes

Tsai et al. Diabetes Care 2014;37:1002-1008

RESULTS

• Associations between lower eGFR and higher prevalence of albuminuria, retinopathy, peripheral arterial disease, and coronary artery disease were robust regardless of filtration marker

• Risk of all-cause mortality increased with lower eGFRcr and eGFRcys

• Only lower eGFRcys was significantly associated with cardiovascular mortality

Tsai et al. Diabetes Care 2014;37:1002-1008

Tsai et al. Diabetes Care 2014;37:1002-1008

CONCLUSIONS

• More people with diabetes had reduced kidney function by eGFRcys than by eGFRcr

• Lower eGFRcys was strongly associated with diabetes complications

• Whether eGFRcys is superior to eGFRcr in approximating true kidney function in a diabetic population requires additional study

Tsai et al. Diabetes Care 2014;37:1002-1008

Tsai et al. Diabetes Care 2014;37:1002-1008

Tsai et al. Diabetes Care 2014;37:1002-1008

Tsai et al. Diabetes Care 2014;37:1002-1008