Relationship of Serum Cystatin C with C-Reactive Protein and Apolipoprotein A1 in Patients on Hemodialysis

Abstract

Cystatin C is considered an indicator of acute renal failure and also a risk factor of cardiovascular disease. This study was undertaken to examine the relationship of serum cystatin C with C-reactive protein (CRP), lipids, and lipid-related compounds in patients on hemodialysis (HD). Cystatin C, CRP, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and apolipoprotein A1 and B were analyzed in serum of 30 patients on HD for 118 ± 18 months with low-flux dialyzers, before and after HD. The results were compared with those obtained by 21 healthy individuals (NC). Multiple regression analysis was performed to evaluate the association of cystatin C concentration before HD with clinical and laboratory parameters. The results showed that cystatin C before HD was not associated with age, body mass index (BMI), or duration of HD. However, it was significantly correlated with creatinine (r = 0.435, p = 0.021) and albumin (r = 0.483, p = 0.009) concentrations. Moreover, a highly significant association was shown with logCRP (r = 0.692, p < 0.0001). Among the lipid and lipid-related compounds studied, a significant correlation was found between cystatin C and apolipoprotein A1 concentrations (r = 0.402, p = 0.034). None of those correlations were observed in the NC group. In conclusion, it seems that cystatin C levels before HD are related with CRP, an important inflammatory factor, and also with apolipoprotein A1, which has been proved to accelerate the atherosclerosis process. However more studies are needed to confirm these findings.

Serum cystatin C as a predictor for cardiovascular events in end-stage renal disease patients at the initiation of dialysis

“…As mentioned earlier, cystatin C seems to be a related inflammatory process. A possible implication of cystatin C in the inflammatory process was seen by a significant correlation with CRP, apolipoprotein A1, and monocytes, which play an important role in chronic inflammation and atherosclerosis [47][48][49]. Ferraro and colleagues recently described that inflammatory cytokines mainly contribute to perturb the cystatin C-cathepsins equilibrium in pathological mechanisms promoting several diseases [50].…”

How should procalcitonin and C‐reactive protein levels be interpreted in haemodialysis patients?

“…[8][9][10][11][12] The high level of PCT, on the other hand, has been linked to the effect of cytokines released due to the microvascular interaction during HD. These studies have reported that both of these parameters are higher than those in the normal population.…”

“…These studies have reported that both of these parameters are higher than those in the normal population. 2,[5][6][7][8][9][10][11][12][13][14][15][16] Studies have linked the high level of CRP to the fact that when leukocytes face the dialysis membranes, the cytokines released from inflammatory cells trigger the inflammatory process. [8][9][10][11][12] The high level of PCT, on the other hand, has been linked to the effect of cytokines released due to the microvascular interaction during HD.…”

The effect of increased frequency of hemodialysis on serum cystatin C and β2‐microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial

“…Cystatin C (CysC) is a small molecular weight protein (molecular weight of 13.3 k Dalton, positively charged with isoelectric point of 9.3) . This protein is produced at a very constant rate and is affected by only a few conditions, such as uncontrolled hyperthyroidism and inflammation . Studies have shown that CysC may be a better surrogate marker for estimating kidney function than creatinine .…”

“…3 This protein is produced at a very constant rate and is affected by only a few conditions, such as uncontrolled hyperthyroidism and inflammation. 4,5 Studies have shown that CysC may be a better surrogate marker for estimating kidney function than creatinine. 6,7 We have published three pilot studies and found that: (1) CysC is removed by hemodialysis treatment, (2) its serum concentration is influenced by the weekly dialysis dose (Std Kt/V urea ) but not the per-treatment Kt/V urea , and (3) its serum concentration is stable between dialysis sessions once patients are on an established dialysis prescription.…”