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Association Between Chronic Kidney Disease Detected Using Creatinine and Cystatin C and Death and Cardiovascular Events in Elderly Mexican Americans: The Sacramento Area Latino Study on Aging
Author(s) -
Peralta Carmen A.,
Lee Anne,
C. Odden Michelle,
Lopez Lenny,
Hazzouri Adina Zeki Al,
Neuhaus John,
Haan Mary N.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12040
Subject(s) - renal function , cystatin c , medicine , kidney disease , creatinine , urology , diabetes mellitus , proportional hazards model , endocrinology
Objectives Creatinine, the current clinical standard to detect chronic kidney disease (CKD), is biased by muscle mass, age and race. The authors sought to determine whether cystatin C, an alternative marker of kidney function less biased by these factors, can identify elderly Mexican Americans with CKD who are at high risk for death and cardiovascular disease. Design Longitudinal, with mean follow‐up of 6.8 years. Setting Sacramento Area Latino Study of Aging ( SALSA ). Participants One thousand four hundred and thirty five Mexican Americans aged 60 to 101. Measurements Estimated glomerular filtration rate (e GFR , mL/min per 1.73 m 2 ) was determined according to creatinine (e GFR creat) and cystatin C (e GFR cys), and participants were classified into four mutually exclusive categories: CKD neither (e GFR creat ≥60 mL/min per 1.73 m 2 ; e GFR cys ≥60 mL/min per 1.73 m 2 ), CKD creatinine only (e GFR creat <60 mL/min per 1.73 m 2 ; e GFR cys ≥60 mL/min per 1.73 m 2 ), CKD cystatin only (e GFR creat ≥60 mL/min per 1.73 m 2 ; e GFR cys <60), and CKD both (e GFR creat <60 mL/min per 1.73 m 2 ; GFR cys <60 mL/min per 1.73 m 2 ). The associations between each CKD classification and all‐cause death and cardiovascular ( CV ) death were studied using Cox regression. Results At baseline, mean age was 71 ± 7; 481 (34%) had diabetes mellitus, and 980 (68%) had hypertension. Persons with CKD both had higher risk for all‐cause ( HR = 2.30, 95% confidence interval ( CI ) = 1.78–2.98) and CV disease (CVD) ( HR = 2.75, 95% CI = 1.96–3.86) death than CKD neither after full adjustment. Persons with CKD cystatin C only were also at greater risk of all‐cause ( HR = 1.91, 95% CI = 1.37–2.67) and CV ( HR = 2.56, 95% CI = 1.64–3.99) death than CKD neither. In contrast, persons with CKD creatinine only were not at greater risk for CV death ( HR = 1.39, 95% CI = 0.71–2.72) but were at higher risk for all‐cause death ( HR = 1.95, 95% CI = 1.27–2.98). Conclusion Cystatin C may be a useful alternative to creatinine for detecting high risk of death and CVD in elderly M exican A mericans with CKD .