Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity
Cystatin C-based estimated glomerular filtration rate (eGFR ) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFR ). Obesity may be associated with higher cystatin C levels, independent of kidney function, but it is unknown whether obesity modifies associations...
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| Vydané v: | American journal of kidney diseases Ročník 83; číslo 4; s. 489 |
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| Hlavní autori: | , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
01.04.2024
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| Abstract | Cystatin C-based estimated glomerular filtration rate (eGFR
) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFR
). Obesity may be associated with higher cystatin C levels, independent of kidney function, but it is unknown whether obesity modifies associations of eGFR
with kidney and cardiovascular outcomes.
Cohort study.
27,249 US adults in the Reasons for Geographic and Racial Differences in Stroke Study.
eGFR
, eGFR
, waist circumference, and body mass index (BMI).
All-cause mortality, kidney failure, incident atherosclerotic cardiovascular disease (ASCVD), and incident heart failure (HF).
Multivariable Cox and Fine-Gray models with multiplicative interaction terms were constructed to investigate whether waist circumference quartiles or BMI categories modified associations of eGFR
with risks of 4 clinical outcomes.
Participants had a mean age of 65 years; 54% were women, 41% were Black, and 21% had an eGFR
<60mL/min/1.73m
. The baseline prevalence of abdominal obesity (waist circumference≥88cm for women or≥102cm for men) was 48% and obesity was 38%. In multivariable adjusted analyses, each 15mL/min/1.73m
lower eGFR
was associated with higher HR and 95% CI of mortality in each waist circumference quartile (first quartile, 1.19 [1.15-1.24]; second quartile, 1.22 [1.18-1.26]; third quartile, 1.20 [1.16-1.24]; fourth quartile, 1.19 [1.15-1.23]) as well as within each BMI category (BMI<24.9: 1.21 [1.17-1.25]; BMI 25.0-29.9: 1.21 [1.18-1.25]; BMI 30.0-34.9: 1.20 [1.16-1.25]; BMI≥35: 1.17, [1.12-1.22]). Neither waist circumference nor BMI modified the association of eGFR
with mortality, kidney failure, incident ASCVD, or incident HF (all P
>0.05).
Included only Black and White persons in the United States.
Obesity did not modify the association of eGFR
with all-cause mortality, kidney failure, incident ASCVD, or incident HF. Among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.
Cystatin C is increasingly used in clinical practice to estimate kidney function, and cystatin C-based eGFR (eGFR
) may be used to determine risk for adverse clinical outcomes. Adiposity may increase serum levels of cystatin C, independent of kidney function. This cohort study investigated whether associations of eGFR
with adverse kidney and cardiovascular outcomes are modified by measures of obesity, waist circumference, and body mass index. We found that obesity does not modify associations of eGFR
with 4 clinical outcomes and conclude that among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes. |
|---|---|
| AbstractList | Cystatin C-based estimated glomerular filtration rate (eGFR
) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFR
). Obesity may be associated with higher cystatin C levels, independent of kidney function, but it is unknown whether obesity modifies associations of eGFR
with kidney and cardiovascular outcomes.
Cohort study.
27,249 US adults in the Reasons for Geographic and Racial Differences in Stroke Study.
eGFR
, eGFR
, waist circumference, and body mass index (BMI).
All-cause mortality, kidney failure, incident atherosclerotic cardiovascular disease (ASCVD), and incident heart failure (HF).
Multivariable Cox and Fine-Gray models with multiplicative interaction terms were constructed to investigate whether waist circumference quartiles or BMI categories modified associations of eGFR
with risks of 4 clinical outcomes.
Participants had a mean age of 65 years; 54% were women, 41% were Black, and 21% had an eGFR
<60mL/min/1.73m
. The baseline prevalence of abdominal obesity (waist circumference≥88cm for women or≥102cm for men) was 48% and obesity was 38%. In multivariable adjusted analyses, each 15mL/min/1.73m
lower eGFR
was associated with higher HR and 95% CI of mortality in each waist circumference quartile (first quartile, 1.19 [1.15-1.24]; second quartile, 1.22 [1.18-1.26]; third quartile, 1.20 [1.16-1.24]; fourth quartile, 1.19 [1.15-1.23]) as well as within each BMI category (BMI<24.9: 1.21 [1.17-1.25]; BMI 25.0-29.9: 1.21 [1.18-1.25]; BMI 30.0-34.9: 1.20 [1.16-1.25]; BMI≥35: 1.17, [1.12-1.22]). Neither waist circumference nor BMI modified the association of eGFR
with mortality, kidney failure, incident ASCVD, or incident HF (all P
>0.05).
Included only Black and White persons in the United States.
Obesity did not modify the association of eGFR
with all-cause mortality, kidney failure, incident ASCVD, or incident HF. Among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.
Cystatin C is increasingly used in clinical practice to estimate kidney function, and cystatin C-based eGFR (eGFR
) may be used to determine risk for adverse clinical outcomes. Adiposity may increase serum levels of cystatin C, independent of kidney function. This cohort study investigated whether associations of eGFR
with adverse kidney and cardiovascular outcomes are modified by measures of obesity, waist circumference, and body mass index. We found that obesity does not modify associations of eGFR
with 4 clinical outcomes and conclude that among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes. Cystatin C-based estimated glomerular filtration rate (eGFRcys) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFRcr). Obesity may be associated with higher cystatin C levels, independent of kidney function, but it is unknown whether obesity modifies associations of eGFRcys with kidney and cardiovascular outcomes.RATIONALE & OBJECTIVECystatin C-based estimated glomerular filtration rate (eGFRcys) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFRcr). Obesity may be associated with higher cystatin C levels, independent of kidney function, but it is unknown whether obesity modifies associations of eGFRcys with kidney and cardiovascular outcomes.Cohort study.STUDY DESIGNCohort study.27,249 US adults in the Reasons for Geographic and Racial Differences in Stroke Study.SETTING & PARTICIPANTS27,249 US adults in the Reasons for Geographic and Racial Differences in Stroke Study.eGFRcys, eGFRcr, waist circumference, and body mass index (BMI).PREDICTORSeGFRcys, eGFRcr, waist circumference, and body mass index (BMI).All-cause mortality, kidney failure, incident atherosclerotic cardiovascular disease (ASCVD), and incident heart failure (HF).OUTCOMEAll-cause mortality, kidney failure, incident atherosclerotic cardiovascular disease (ASCVD), and incident heart failure (HF).Multivariable Cox and Fine-Gray models with multiplicative interaction terms were constructed to investigate whether waist circumference quartiles or BMI categories modified associations of eGFRcys with risks of 4 clinical outcomes.ANALYTICAL APPROACHMultivariable Cox and Fine-Gray models with multiplicative interaction terms were constructed to investigate whether waist circumference quartiles or BMI categories modified associations of eGFRcys with risks of 4 clinical outcomes.Participants had a mean age of 65 years; 54% were women, 41% were Black, and 21% had an eGFRcys<60mL/min/1.73m2. The baseline prevalence of abdominal obesity (waist circumference≥88cm for women or≥102cm for men) was 48% and obesity was 38%. In multivariable adjusted analyses, each 15mL/min/1.73m2 lower eGFRcys was associated with higher HR and 95% CI of mortality in each waist circumference quartile (first quartile, 1.19 [1.15-1.24]; second quartile, 1.22 [1.18-1.26]; third quartile, 1.20 [1.16-1.24]; fourth quartile, 1.19 [1.15-1.23]) as well as within each BMI category (BMI<24.9: 1.21 [1.17-1.25]; BMI 25.0-29.9: 1.21 [1.18-1.25]; BMI 30.0-34.9: 1.20 [1.16-1.25]; BMI≥35: 1.17, [1.12-1.22]). Neither waist circumference nor BMI modified the association of eGFRcys with mortality, kidney failure, incident ASCVD, or incident HF (all Pinteraction>0.05).RESULTSParticipants had a mean age of 65 years; 54% were women, 41% were Black, and 21% had an eGFRcys<60mL/min/1.73m2. The baseline prevalence of abdominal obesity (waist circumference≥88cm for women or≥102cm for men) was 48% and obesity was 38%. In multivariable adjusted analyses, each 15mL/min/1.73m2 lower eGFRcys was associated with higher HR and 95% CI of mortality in each waist circumference quartile (first quartile, 1.19 [1.15-1.24]; second quartile, 1.22 [1.18-1.26]; third quartile, 1.20 [1.16-1.24]; fourth quartile, 1.19 [1.15-1.23]) as well as within each BMI category (BMI<24.9: 1.21 [1.17-1.25]; BMI 25.0-29.9: 1.21 [1.18-1.25]; BMI 30.0-34.9: 1.20 [1.16-1.25]; BMI≥35: 1.17, [1.12-1.22]). Neither waist circumference nor BMI modified the association of eGFRcys with mortality, kidney failure, incident ASCVD, or incident HF (all Pinteraction>0.05).Included only Black and White persons in the United States.LIMITATIONSIncluded only Black and White persons in the United States.Obesity did not modify the association of eGFRcys with all-cause mortality, kidney failure, incident ASCVD, or incident HF. Among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.CONCLUSIONObesity did not modify the association of eGFRcys with all-cause mortality, kidney failure, incident ASCVD, or incident HF. Among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.Cystatin C is increasingly used in clinical practice to estimate kidney function, and cystatin C-based eGFR (eGFRcys) may be used to determine risk for adverse clinical outcomes. Adiposity may increase serum levels of cystatin C, independent of kidney function. This cohort study investigated whether associations of eGFRcys with adverse kidney and cardiovascular outcomes are modified by measures of obesity, waist circumference, and body mass index. We found that obesity does not modify associations of eGFRcys with 4 clinical outcomes and conclude that among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.PLAIN-LANGUAGE SUMMARYCystatin C is increasingly used in clinical practice to estimate kidney function, and cystatin C-based eGFR (eGFRcys) may be used to determine risk for adverse clinical outcomes. Adiposity may increase serum levels of cystatin C, independent of kidney function. This cohort study investigated whether associations of eGFRcys with adverse kidney and cardiovascular outcomes are modified by measures of obesity, waist circumference, and body mass index. We found that obesity does not modify associations of eGFRcys with 4 clinical outcomes and conclude that among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes. |
| Author | Scherzer, Rebecca Bullen, Alexander L Garimella, Pranav S Kramer, Holly J Chen, Debbie C Estrella, Michelle M Ilori, Titilayo Ix, Joachim H Nadkarni, Girish Shlipak, Michael G Crews, Deidra C Gutierrez, Orlando |
| Author_xml | – sequence: 1 givenname: Debbie C surname: Chen fullname: Chen, Debbie C organization: Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco; Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Genentech, Inc., South San Francisco – sequence: 2 givenname: Rebecca surname: Scherzer fullname: Scherzer, Rebecca organization: Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Department of Medicine, San Francisco VA Medical Center, San Francisco – sequence: 3 givenname: Joachim H surname: Ix fullname: Ix, Joachim H organization: Division of Nephrology-Hypertension, University of California at San Diego, San Diego; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Dieg, California – sequence: 4 givenname: Holly J surname: Kramer fullname: Kramer, Holly J organization: Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, Illinois – sequence: 5 givenname: Deidra C surname: Crews fullname: Crews, Deidra C organization: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 6 givenname: Girish surname: Nadkarni fullname: Nadkarni, Girish organization: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Clinical Intelligence Cente, Icahn School of Medicine at Mount Sinai, New York, New York – sequence: 7 givenname: Orlando surname: Gutierrez fullname: Gutierrez, Orlando organization: Division of Nephrology, UAB Heersink School of Medicine, Birmingham, Alabama – sequence: 8 givenname: Alexander L surname: Bullen fullname: Bullen, Alexander L organization: Division of Nephrology-Hypertension, University of California at San Diego, San Diego; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Dieg, California – sequence: 9 givenname: Titilayo surname: Ilori fullname: Ilori, Titilayo organization: Section of Nephrology, Department of Medicine, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts – sequence: 10 givenname: Pranav S surname: Garimella fullname: Garimella, Pranav S organization: Division of Nephrology-Hypertension, University of California at San Diego, San Diego – sequence: 11 givenname: Michael G surname: Shlipak fullname: Shlipak, Michael G organization: Department Epidemiology and Biostatistics, University of California at San Francisco, San Francisco; Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Department of Medicine, San Francisco VA Medical Center, San Francisco – sequence: 12 givenname: Michelle M surname: Estrella fullname: Estrella, Michelle M email: michelle.estrella@ucsf.edu organization: Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco; Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Division of Nephrology, San Francisco VA Medical Center, San Francisco; Department of Medicine, San Francisco VA Medical Center, San Francisco. Electronic address: michelle.estrella@ucsf.edu |
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| Keywords | cystatin C Cardiovascular disease chronic kidney disease estimated glomerular filtration rate obesity |
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| Snippet | Cystatin C-based estimated glomerular filtration rate (eGFR
) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFR
).... Cystatin C-based estimated glomerular filtration rate (eGFRcys) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFRcr).... |
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| SubjectTerms | Adult Aged Atherosclerosis Cohort Studies Creatinine Cystatin C - metabolism Female Glomerular Filtration Rate Humans Kidney Male Obesity - complications Obesity - epidemiology Renal Insufficiency Renal Insufficiency, Chronic - epidemiology United States - epidemiology |
| Title | Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity |
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