The Value of a Cystatin C-based Estimated Glomerular Filtration Rate for Cardiovascular Assessment in a General Japanese Population: Results From the Iwate Tohoku Medical Megabank Project
The Value of a Cystatin C-based Estimated Glomerular Filtration Rate for Cardiovascular Assessment in a General Japanese Population: Results From the Iwate Tohoku Medical Megabank Project
复制标题
DOI：
10.2188/jea.je20180274
复制
发表时间：
2020-06-01
影响因子：
4.7
通讯作者：
Sasaki, Makoto
中科院分区：
文献类型：
--
作者：
Osaki, Takuya;Satoh, Mamoru;Sasaki, Makoto
背景：流行病学研究表明，高循环的胱抑素C与心血管疾病(CVD)的风险相关，而不依赖于基于肌酐的肾功能测量。本研究调查了基于胱抑素C的估计肾小球滤过率(GFRcys)和基于肌酐的肾小球滤过率(GFRcr)之间的比较，以确定这些测量是否与日本普通人群中的心血管生物标志物和心血管疾病风险增加相关。方法：岩手县医疗巨型银行组织汇集了岩手县普通人群队列研究(n=29,375)的个人参与者数据。用GFRcr、GFRcr和尿白蛋白/肌酐(UACr)来评估慢性肾脏疾病(CKD)。校正基线特征后的多因素分析显示，高敏心肌肌钙蛋白T(hs-cTnT)和N端脑利钠肽原(NT-proBNP)与GFRcys相关。用于识别Suita分数高的个体的受试者操作特征(AUROC)曲线下面积，GFRcys(AUROC=0.68)高于GFRcr(AUROC=0.64，P<；0.001)。GFRcys通过GFRcr对心血管疾病风险预测模型进行了重分类改进(净重分类改进=0.341，综合判别度改进=0.018，P<；0.001)。结论：GFRcys与心血管生物标志物(包括hs-cTnT和NT-proBNP水平)的相关性更密切，评分也比GFRcr高，在应用GFRcr评估心血管疾病风险方面提供了额外的价值。
Background: Epidemiological studies have shown that high circulating cystatin C is associated with a risk of cardiovascular disease (CVD) independent of creatinine-based renal function measurements. The present study investigated the comparison between the cystatin C-based estimated glomerular filtration rate (GFRcys) and creatinine-based GFR (GFRcr) to determine whether these measurements are associated with CV biomarkers and elevated CVD risk in a general Japanese population.Methods: The Iwate Tohoku Medical Megabank Organization pooled individual participant data from a general population-based cohort study in Iwate prefecture (n = 29,375). Chronic kidney disease (CKD) was estimated using the GFRcys, GFRcr and the urine albumin-to-creatinine ratio (UACR).Results: The prevalence of CKD in the participants was found to be higher based on the GFRcr than the GFRcys. Multiple variable analyses after adjusting for baseline characteristics showed that high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were associated with the GFRcys. The area under the receiver operating characteristic (AUROC) curve for identifying individuals with a high Suita score was higher for the GFRcys (AUROC = 0.68) than it was for the GFRcr (AUROC = 0.64, P < 0.001). The GFRcys provided reclassification improvement for the CVD risk prediction model by the GFRcr (net reclassification improvement = 0.341; integrated discrimination improvement = 0.018, respectively, P < 0.001).Conclusions: The GFRcys is more closely associated with CV biomarkers, including hs-cTnT and NT-proBNP levels, and a high Suita score than the GFRcr, and it provides additional value in the assessment of CVD risk using GFRcr.