Discordance between cystatin C-based and creatinine-based estimated glomerular filtration rate and mortality in the general population (original) (raw)

Liu, Qiaoling, Celis-Morales, Carlos ORCID: https://orcid.org/0000-0003-2612-3917, Lees, Jennifer S. ORCID: https://orcid.org/0000-0001-6331-0178, Sattar, Naveed ORCID: https://orcid.org/0000-0002-1604-2593, Ho, Frederick K. ORCID: https://orcid.org/0000-0001-7190-9025, Pell, Jill P. ORCID: https://orcid.org/0000-0002-8898-7035, Mark, Patrick B. ORCID: https://orcid.org/0000-0003-3387-2123 and Welsh, Paul ORCID: https://orcid.org/0000-0002-7970-3643(2025) Discordance between cystatin C-based and creatinine-based estimated glomerular filtration rate and mortality in the general population.Clinical Chemistry, 71(8), pp. 858-869. (doi: 10.1093/clinchem/hvaf063) (PMID:40464748)

Abstract

BACKGROUND: The consequences for health outcomes of the discordance in cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates are gaining attention. However, the association of discordance with all-cause mortality in the general population has not been explored. METHODS: A total of 325 356 UK Biobank participants, 40 to 69 years of age, were followed for a median of 13.7 years. eGFR was calculated using both the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009/2012 equations and the European Kidney Function Consortium (EKFC) equations. Differences were expressed as the absolute difference (eGFRcys − eGFRcr, where discordance was defined as ±15 mL/min/1.73 m2 difference) and relative difference (eGFRcys/eGFRcr, where discordance was defined as eGFRcys < 60% eGFRcr). Hazard ratios (HRs) for mortality were estimated using multivariable Cox proportional hazards models. RESULTS: Among the participants, 15.5% had a discordant lower absolute eGFRcys, and 8.5% had a discordant higher absolute eGFRcys. Participants with discordant lower absolute eGFRcys (both CKD-EPI and EKFC equations) were older, more frequently male, had higher body mass index (BMI) and blood pressure, more comorbidities, and did less physical activity. A total of 26 465 deaths occurred. Participants with discordant lower eGFRcys had a 53% higher risk of mortality (HR = 1.53: 95% CI, 1.48–1.57), while those with discordant higher eGFRcys had a 30% lower risk (HR = 0.70: 95% CI, 0.66–0.75) compared to those with concordant eGFR. Those with discordance of lower relative eGFRcys had doubled risk of mortality (HR = 2.25: 95% CI, 2.04–2.47). CONCLUSIONS: eGFR discordance was prevalent and associated with mortality in general populations. These results support broader use of cystatin C for risk stratification of mortality.

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Funder and Project Information

Kidney function as a modulator of cancer treatment: a comprehensive analysis from population data, health records, national registries and individual participant-level trial data.

Jennifer Lees

301005/Z/23/Z

SCMH - Cardiovascular & Metabolic Health

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