Measured glomerular filtration rate does not improve prediction of mortality
          by cystatin C and creatinine

Sundin, Per-Ola; Sjöström, Per; Jones, Ian; Olsson, Lovisa; Udumyan, Ruzan; Grubb, Anders; Lindström, Veronica; Montgomery, Scott

doi:10.1093/ndt/gfx004

Cited by 16 publications

(13 citation statements)

References 53 publications

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“…The long-term mortality6, 7, 8 and morbidity8, 9 of patients with SPS have been shown to be strongly increased in several cohorts, even in the absence of reduced GFR. Moreover, cardiovascular manifestations have represented a major part of the mortality 6, 7, 8, 9, 10. All of these studies have used cystatin C−based and/or creatinine-based GFR estimating equations to estimate GFR, but in an ongoing investigation of 2805 patients with measured GFR, SPS is also associated with a markedly shortened survival (A. Grubb, J. Björk, unpublished data).…”

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confidence: 99%

Shrunken Pore Syndrome Is Associated With Increased Levels of Atherosclerosis-Promoting Proteins

Almén

Björk

Nyman

et al. 2019

Kidney International Reports

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IntroductionShrunken pore syndrome (SPS), originally defined by cystatin C−based estimated glomerular filtration rate (eGFRcystatin C) being less than 60% of creatinine-based estimated glomerular filtration rate (eGFRcreatinine) in the absence of extrarenal influences on the plasma levels of cystatin C or creatinine, is associated with a high increase in mortality, even in the absence of reduced glomerular filtration rate (GFR). The objective of the present study was to determine whether the proteome of patients with SPS shows differences from that of patients with normal or reduced measured GFR (mGFR) without SPS.MethodsFour patient cohorts were included: 1 cohort with normal mGFR without SPS, 1 with normal mGFR with SPS, 1 with reduced mGFR without SPS, and 1 with reduced mGFR with SPS. The plasma levels of 177 selected proteins were analyzed.ResultsDifferences in the levels of 30 proteins were specific for SPS; 31 differences were specific for patients with both SPS and reduced mGFR; and 27 were specific for reduced mGFR. Eighteen of the differences specific for SPS concerned proteins described as promoting, or being associated with, atherosclerosis. Twelve of the differences specific for patients with both SPS and reduced mGFR and 10 of the differences specific for reduced mGFR also concerned proteins described as promoting, or being associated with, atherosclerosis. Almost all (82 of 88) of the concentration differences represented increased levels. For SPS, but not for reduced mGFR, a correlation between protein size and increase in level was observed, with smaller proteins being associated with higher levels.ConclusionThe high mortality in shrunken pore syndrome might be caused by the accumulation of atherosclerosis-promoting proteins in this condition.

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confidence: 99%

Shrunken Pore Syndrome Is Associated With Increased Levels of Atherosclerosis-Promoting Proteins

Almén

Björk

Nyman

et al. 2019

Kidney International Reports

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“…Some authors note that the simultaneous determination of cystatin C and creatinine helps to give a more accurate assessment of factors, both related to the glomerular filtration rate and not related to it, as well as to obtain a more accurate prognosis of adverse outcomes [15].…”

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confidence: 99%

Clinical laboratory diagnosis of obstructive megaureter in children

Svekatun

Dmitriakov

Lytvynenko

2020

PPS

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Introduction. Currently, there are more than 200 methods of surgical treatment of a megaureter, but none of the methods has achieved universal acceptance. Until now, the issues of differential diagnosis of organic and functional causes of ureteral dilatation in children under 3 years of age have not been sufficiently illuminated, there is no generally accepted algorithm for the management of patients with this pathology.Relevance. The relevance of obstructive uropathies is evidenced by the fact that they occupy the third position in the list of the most common causes of chronic kidney disease in children, and account for 15% of cases. The prognosis of the outcome of obstructive uropathy is determined by the nature of the lesion and the degree of involvement in the pathological process of the kidneys, one of the main homeostatic and endocrine organs in humans. The degree of involvement of various markers in the development and progression of kidney damage in children is still insufficiently understood. All this prompts the search for screening, highly sensitive and specific methods for the diagnosis and prediction of nephrosclerotic changes in children against the background of urinary tract obstruction. Objective:The study of the clinical and laboratory diagnostic methods, allowing to differentiate functional or organic urodynamic disorders, to determine the tactics of managing patients with obstructive uropathy.12 Materials and methods. Since 2016, a study has been conducted of 174 children aged 0 to 18 years. 3 groups of children were identified: 1) with endoscopic treatment (main group);2) treated with an open surgical method (control group); and 3) a group of children without urinary tract obstruction (reference group). Results.In the course of the study, it was found that the most optimal values of serum cystatin C, close to the reference group (0.048-0.831 mg/ml) were obtained in children treated with endoscopic correction of the intramural ureter (0.217-0.798 mg/ml). Conclusions. The tactics of endoscopic treatment of obstructive uropathies in children has advantages in terms of open surgical methods in technical simplicity, minimally invasiveness, maximum physiology, and a decrease in the frequency of postoperative complications. These theses are confirmed by the obtained results of the study of serum cystatin C as a marker of the state of renal filtration. It should be remembered that the effectiveness of endoscopic stenting of the lower ureter depends on the age of the child.

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“…The objective of this study is to explore the differences in outcomes between older individuals with eGFR levels equivalent to CKD stages 1, 2, 3a and 3b [12]. The outcomes in focus are well-known consequences of kidney disease, with mortality as the primary endpoint and incident acute CVD, incident congestive heart failure (CHF), ESRD and rapid kidney function decline (RKFD) as secondary endpoints.…”

Section: Introductionmentioning

confidence: 99%

Cystatin C and creatinine-based eGFR levels and their correlation to long-term morbidity and mortality in older adults

et al. 2018

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BackgroundThe prevailing diagnostic criteria for CKD are age-independent, but have been challenged in light of the eGFR decline associated with normal aging. The stages of CKD communicate magnitude of risk of ESRD, cardiovascular morbidity, and mortality.AimsThis study aims to provide more insight into the morbidity and mortality associated with eGFR levels corresponding to the current CKD stages in older adults.MethodsThe 2931 older adults in the Good Aging in Skåne study were randomized from the general population. The exposure variable used was eGFR level (CKD-EPI based on creatinine and cystatin C) with eGFR 60–89 mL/min/1.73 m2 as a reference; the outcomes were mortality, acute cardiovascular disease, congestive heart failure, and rapid kidney function decline (RKFD; defined as a decline in eGFR by 3 mL/min/1.73 m2 per year or more).ResultsThe mean age at baseline was 73 (SD 11) and mean follow-up time 11 (SD 5) years. Mortality was higher at lower eGFR levels with adjusted HR (95% CI) being 1.58 (1.34–1.88), 1.22 (1.05–1.41), 1 (reference), and 0.90 (0.67–1.21) for eGFR < 45, 45–59, 60–89 and ≥ 90 mL/min/1.73 m2, respectively. For acute CVD the adjusted HR (95% CI) were 1.23 (0.81–1.87), 1.21 (0.87–1.69), 1 (reference), and 0.53 (0.28–1.00) for the same eGFR levels.ConclusionsThis study confirms that mortality in older adults increases with decreasing eGFR at eGFR levels below today’s threshold for CKD. The correlation was less certain for lower eGFR and incident cardiovascular disease.Electronic supplementary materialThe online version of this article (10.1007/s40520-018-1091-x) contains supplementary material, which is available to authorized users.

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Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine

Abstract: Our results suggest that both creatinine and cystatin C have independent associations with mortality not explained entirely by mGFR and that mGFR does not offer a more precise mortality risk assessment than these endogenous filtration markers combined.

Cited by 16 publications

References 53 publications

Shrunken Pore Syndrome Is Associated With Increased Levels of Atherosclerosis-Promoting Proteins

Shrunken Pore Syndrome Is Associated With Increased Levels of Atherosclerosis-Promoting Proteins

Clinical laboratory diagnosis of obstructive megaureter in children

Cystatin C and creatinine-based eGFR levels and their correlation to long-term morbidity and mortality in older adults

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