Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank.
Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank.
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DOI：
10.1161/jaha.122.027079
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发表时间：
2023-02-07
影响因子：
5.4
通讯作者：
Estrella, Michelle M.
中科院分区：
文献类型：
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作者：
Chen, Debbie C.;Lees, Jennifer S.;Lu, Kaiwei;Scherzer, Rebecca;Rutherford, Elaine;Mark, Patrick B.;Kanaya, Alka M.;Shlipak, Michael G.;Estrella, Michelle M.
关键词：
南亚人患心血管疾病和死亡的风险增加。依赖肌酐而不是基于胱抑素 C 的估计肾小球滤过率 (eGFRcys) 可能会低估与慢性肾脏病相关的心血管疾病风险。在 7738 名未患有心力衰竭 (HF) 或动脉粥样硬化性心血管疾病的南亚裔英国生物银行参与者中，我们研究了 4 个 eGFRcys 和基于肌酐的估计肾小球滤过率类别（<45、45-59、60-89 和 ≥90mL/min/1.73m2）与全因死亡、心力衰竭和意外事件风险的关联动脉粥样硬化性心血管疾病。平均年龄为53±8岁； 4085 名 (53%) 是女性。与肌酐相比，胱抑素 C 发现估计肾小球滤过率 <45 的参与者人数增加了三倍（n=35 与 n=113），估计肾小球滤过率 45 至 59 的参与者人数增加了 6 倍（n=80 与 n=481）。经过多变量调整后，与 eGFRcys ≥90 类别相比，eGFRcys 45 至 59 类别与较高的死亡风险（风险比 [HR]，2.38 [95% CI，1.55–3.65]）和心力衰竭（亚 HR [sHR]，1.87 [95% CI，1.09–3.22]））相关；基于肌酐的估计肾小球滤过率 45 至 59 类别与结果没有显着相关性。在 7623 名基于肌酐的估计肾小球滤过率≥60 的参与者中，498 名 (6.5%) 被重新分类为 eGFRcys <60 类别。被重新分类为 eGFRcys <45 的参与者具有较高的死亡风险 (HR, 4.88 [95% CI, 2.56–9.31])、发生心力衰竭 (sHR, 4.96 [95% CI, 2.21–11.16]) 和发生动脉粥样硬化性心血管疾病 (sHR, 2.29 [95% CI, 1.14–4.61])与 eGFRcys ≥ 90 的患者相比；那些被重新分类为 eGFRcys 45 至 59 的患者的死亡风险增加一倍（HR，2.25 [95% CI，1.45-3.51]）。在南亚个体中，胱抑素 C 确定了肌酐未检测到的高危慢性肾病人群，并增强了基于估计肾小球滤过率的死亡率、心力衰竭和动脉粥样硬化性心血管疾病的风险分层。
South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine‐ rather than cystatin C–based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine‐based estimated glomerular filtration rate categories (<45, 45–59, 60–89, and ≥90 mL/min per 1.73 m2) with risks of all‐cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55–3.65]) and incident HF (sub‐HR [sHR], 1.87 [95% CI, 1.09–3.22]) versus the eGFRcys ≥90 category; the creatinine‐based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine‐based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56–9.31]), incident HF (sHR, 4.96 [95% CI, 2.21–11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14–4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45–3.51]). Among South Asian individuals, cystatin C identified a high‐risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate–based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.