Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project
Por:
Rothenbacher, D, Rehm, M, Iacoviello, L, Costanzo, S, Tunstall-Pedoe, H, Belch, JJF, Soderberg, S, Hultdin, J, Salomaa, V, Jousilahti, P, Linneberg, A, Sans, S, Padro, T, Thorand, B, Meisinger, C, Kee, F, McKnight, AJ, Palosaari, T, Kuulasmaa, K, Waldeyer, C, Zeller, T, Blankenberg, S, Koenig, W, BiomarCaRE Consortium
Publicada:
9 nov 2020
Resumen:
Background Chronic kidney disease has emerged as a strong cardiovascular risk factor, and in many current guidelines, it is already considered as a coronary heart disease (CHD) equivalent. Routinely, creatinine has been used as the main marker of renal function, but recently, cystatin C emerged as a more promising marker. The aim of this study was to assess the comparative cardiovascular and mortality risk of chronic kidney disease (CKD) using cystatin C-based and creatinine-based equations of the estimated glomerular filtration rate (eGFR) in participants of population-based and disease cohorts. Methods The present study has been conducted within the BiomarCaRE project, with harmonized data from 20 population-based cohorts (n = 76,954) from 6 European countries and 3 cardiovascular disease (CVD) cohorts (n = 4982) from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for the Systematic COronary Risk Evaluation (SCORE) variables and study center. Main outcome measures were cardiovascular diseases, cardiovascular death, and all-cause mortality. Results The overall prevalence of CKD stage 3-5 by creatinine- and cystatin C-based eGFR, respectively, was 3.3% and 7.4% in the population-based cohorts and 13.9% and 14.4% in the disease cohorts. CKD was an important independent risk factor for subsequent CVD events and mortality. For example, in the population-based cohorts, the HR for CVD mortality was 1.72 (95% CI 1.53 to 1.92) with creatinine-based CKD and it was 2.14 (95% CI 1.90 to 2.40) based on cystatin-based CKD compared to participants without CKD. In general, the HRs were higher for cystatin C-based CKD compared to creatinine-based CKD, for all three outcomes and risk increased clearly below the conventional threshold for CKD, also in older adults. Net reclassification indices were larger for a cystatin-C based CKD definition. Differences in HRs (between the two CKD measures) in the disease cohorts were less pronounced than in the population-based cohorts. Conclusion CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of creatinine- and cystatin C-based CKD differed considerably between low- and high-risk populations. Especially in low-risk settings, the use of cystatin C-based CKD may result in more accurate risk estimates and have better prognostic value.
Filiaciones:
Rothenbacher, D:
Ulm Univ, Inst Epidemiol & Med Biometry, Helmholtzstr 22, D-89081 Ulm, Germany
German Canc Res Ctr, Div Clin Epidemiol & Aging Res C070, Heidelberg, Germany
Rehm, M:
Ulm Univ, Inst Epidemiol & Med Biometry, Helmholtzstr 22, D-89081 Ulm, Germany
Iacoviello, L:
IRCCS Neuromed, Dept Epidemiol & Prevent, Pozzilli, Italy
Univ Insubria, Dept Med & Surg, Res Ctr Epidemiol & Prevent Med EPIMED, Varese, Italy
Costanzo, S:
IRCCS Neuromed, Dept Epidemiol & Prevent, Pozzilli, Italy
Tunstall-Pedoe, H:
Univ Dundee, Inst Cardiovasc Res, Cardiovasc Epidemiol Unit, Dundee, Scotland
Belch, JJF:
Univ Dundee, Inst Cardiovasc Dis, Vasc Med Unit, Dundee, Scotland
Soderberg, S:
Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden
Hultdin, J:
Umea Univ, Dept Med Biosci, Clin Chem, Umea, Sweden
Salomaa, V:
Finnish Inst Hlth & Welf, Helsinki, Finland
Jousilahti, P:
Finnish Inst Hlth & Welf, Helsinki, Finland
Linneberg, A:
Bispebjerg & Frederiksberg Hosp, Ctr Clin Res & Prevent, Copenhagen, Denmark
Sans, S:
Catalan Dept Hlth, Barcelona 08005, Spain
Padro, T:
IIB St Pau, Res Inst Hosp Santa Creu & St Pau, Cardiovasc ICCC Program, Barcelona, Spain
Thorand, B:
German Res Ctr Environm Hlth, Helmholtz Zentrum Munchen, Inst Epidemiol, Neuherberg, Germany
Meisinger, C:
German Res Ctr Environm Hlth, Helmholtz Zentrum Munchen, Independent Res Grp Clin Epidemiol, Neuherberg, Germany
Ludwig Maximilians Univ Munchen, Chair Epidemiol UNIKAT Augsburg, Augsburg, Germany
Kee, F:
Queens Univ Belfast, UK Clin Res Collaborat Ctr Excellence Publ Hlth, Belfast, Antrim, North Ireland
McKnight, AJ:
Queens Univ Belfast, Sch Med Dent & Biomed Sci, Ctr Publ Hlth, Belfast, Antrim, North Ireland
Palosaari, T:
Finnish Inst Hlth & Welf, Helsinki, Finland
Kuulasmaa, K:
Finnish Inst Hlth & Welf, Helsinki, Finland
Waldeyer, C:
Univ Heart Ctr Hamburg, Clin Gen & Intervent Cardiol, Hamburg, Germany
Zeller, T:
Univ Heart Ctr Hamburg, Clin Gen & Intervent Cardiol, Hamburg, Germany
Partner Site Hamburg, German Ctr Cardiovasc Res DZHK EV, Hamburg, Germany
Blankenberg, S:
Univ Heart Ctr Hamburg, Clin Gen & Intervent Cardiol, Hamburg, Germany
Partner Site Hamburg, German Ctr Cardiovasc Res DZHK EV, Hamburg, Germany
Koenig, W:
Ulm Univ, Inst Epidemiol & Med Biometry, Helmholtzstr 22, D-89081 Ulm, Germany
Tech Univ Munich, Deutsch Herzzentrum Munchen, Munich, Germany
Partner Site Munich Heart Alliance, DZHK German Ctr Cardiovasc Res, Munich, Germany
Gold, Green Published
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