Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index.
Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index.
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DOI：
10.1053/j.ajkd.2008.12.043
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发表时间：
2009-06
期刊：
影响因子：
--
通讯作者：
Muntner P
中科院分区：
文献类型：
--
作者：
Vupputuri S;Fox CS;Coresh J;Woodward M;Muntner P
肥胖与胱抑素C有关。基于胱抑素C的肾小球滤过率（GFR）方程可能导致在较高的体重指数（BMI）水平下高估慢性肾脏病（CKD）患病率。6,709名美国成人NHANES III参与者。根据BMI水平，基于肌酐和半胱氨酸蛋白酶抑制剂C的估计方程之间3期或4期CKD患病率的绝对百分比差异。正常体重、超重和肥胖分别定义为BMI水平18.5至<25.0、25至<30.0和≥30 kg/m2。CKD 3期或4期（eGFR为15 - 59 ml/min/1.73 m2）使用简化的基于肌酐的肾脏疾病饮食改良公式定义（eGFRMDRD）;胱抑素C、年龄、性别和人种方程（eGFRCysC、年龄、性别、人种）;仅半胱氨酸蛋白酶抑制剂C方程（eGFRCysC）;胱抑素C≥1.12 mg/L（胱抑素C升高）;以及纳入血清肌酐、胱抑素C、年龄、性别和人种的方程（eGFRCr、CysC、年龄、性别、人种）。eGFRCysC、年龄、性别、种族、eGFRCysC和胱抑素C升高之间的3期或4期CKD患病率差异在较高BMI水平下较大。具体而言，与使用eGFRMDRD得出的估计值相比，对于正常体重、超重和肥胖受试者，根据eGFRCysC、年龄、性别、种族估计的3期或4期CKD的患病率分别高出2.1%、3.0%和6.5%。（p趋势=0.005）; eGFRCysC分别高0.1%、0.6%、2.2%（p趋势=0.028）;胱抑素C升高分别高2.9%、5.2%和9.5%（p趋势<0.001）; eGFRCr、CysC、年龄、性别、人种分别高出− 0.1%、− 0.4%和0.0%（p趋势=0.719）。没有GFR的金标准测量。当使用基于胱抑素C的方程时，BMI可能影响3期或4期CKD的患病率。
Adiposity is associated with cystatin C. Cystatin C-based glomerular filtration rate (GFR) equations may result in the over-estimation of chronic kidney disease (CKD) prevalence at higher body mass index (BMI) levels. Cross-sectional 6,709 US adult NHANES III participants. Body mass index Absolute percent difference in the prevalence of stage 3 or 4 CKD between creatinine- and cystatin C-based estimating equations by level of BMI. Normal weight, overweight, and obesity were defined as BMI levels of 18.5 to <25.0, 25 to <30.0, and ≥30 kg/m2, respectively. Stage 3 or 4 CKD (eGFR of 15 to 59 ml/min/1.73m2) was defined using the abbreviated creatinine-based Modification of Diet in Renal Disease equation (eGFRMDRD); a cystatin C, age, sex, and race equation (eGFRCysC,age,sex,race); a cystatin C only equation (eGFRCysC); cystatin C≥1.12 mg/L (elevated cystatin C); and an equation incorporating serum creatinine, cystatin C, age, sex, and race (eGFRCr,CysC,age,sex,race). The differences in stage 3 or 4 CKD prevalence between eGFRCysC,age,sex,race, eGFRCysC, and elevated cystatin C, separately, and eGFRMDRD were larger at higher BMI levels. Specifically, compared to estimates derived using eGFRMDRD, for normal weight, overweight, and obese participants, the prevalence of stage 3 or 4 CKD was 2.1%, 3.0%, and 6.5% higher, respectively, when estimated by eGFRCysC,age,sex,race (p-trend=0.005); 0.1%, 0.6%, 2.2% higher, respectively, for eGFRCysC (p-trend=0.028); 2.9%, 5.2%, and 9.5% higher, respectively, for elevated cystatin C (p-trend<0.001); and −0.1%, −0.4%, and 0.0% higher, respectively, for eGFRCr,CysC,age,sex,race (p-trend=0.719). No gold standard measure of GFR was available. BMI may influence the prevalence of stage 3 or 4 CKD when cystatin C-based equations are used.
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