Serum concentration of cystatin C and risk of end-stage renal disease in diabetes.
Serum concentration of cystatin C and risk of end-stage renal disease in diabetes.
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DOI：
10.2337/dc11-2220
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发表时间：
2012-11
期刊：
影响因子：
16.2
通讯作者：
Groop PH
中科院分区：
文献类型：
--
作者：
Krolewski AS;Warram JH;Forsblom C;Smiles AM;Thorn L;Skupien J;Harjutsalo V;Stanton R;Eckfeldt JH;Inker LA;Groop PH
糖尿病患者患终末期肾病（ESRD）的风险很高。我们检查了根据基于肌酐的肾小球滤过率 (eGFRcreat) 估计的慢性肾脏病 (CKD) 分期对这一结果的预测是否可以通过基于血清胱抑素 C 的估计 (eGFRcyst) 的进一步分期得到改善。 CKD 1-3 期糖尿病患者选自三个队列：两个来自 Joslin 糖尿病中心，一个患有 1 型糖尿病 (N = 364)，一个患有 2 型糖尿病 (N = 402)，第三个来自芬兰糖尿病肾病 (FinnDiane) 研究 1 型 (N = 399)。测量所有患者的肌酐和胱抑素 C 基线血清浓度。随访平均为 8-10 年，并确定了 ESRD 的发作 (n = 246) 和与 ESRD 无关的死亡 (n = 159)。尽管对于 62% 的 Joslin 患者和 73% 的 FinnDiane 患者，eGFRcyst 的 CKD 分期与 eGFRcreat 的分期一致，但在所有三个队列中，eGFRcyst 分期高于 eGFRcreat 的患者的 ESRD 风险显着高于分期一致的患者（风险比 2.3 [95% CI 1.8-3.1]）。同样，eGFRcyst 分期低于 eGFRcreat 分期的患者的风险低于分期一致的患者 (0.30 [0.13–0.68])。与 ESRD 无关的死亡遵循相同的模式，但差异没有那么大。在糖尿病患者中，基于 eGFRcyst 的 CKD 分期显着改善了基于 eGFRcreat 的 ESRD 风险分层。这一结论可以推广到 1 型和 2 型糖尿病患者以及美国和芬兰的糖尿病患者。
Patients with diabetes have a high risk of end-stage renal disease (ESRD). We examined whether prediction of this outcome, according to chronic kidney disease (CKD) staging by creatinine-based estimates of the glomerular filtration rate (eGFRcreat), is improved by further staging with serum cystatin C–based estimates (eGFRcyst). Patients with diabetes in CKD stages 1–3 were selected from three cohorts: two from Joslin Diabetes Center, one with type 1 diabetes (N = 364) and one with type 2 diabetes (N = 402), and the third from the Finnish Diabetic Nephropathy (FinnDiane) Study of type 1 (N = 399). Baseline serum concentrations of creatinine and cystatin C were measured in all patients. Follow-up averaged 8–10 years and onsets of ESRD (n = 246) and death unrelated to ESRD (n = 159) were ascertained. Although CKD staging by eGFRcyst was concordant with that by eGFRcreat for 62% of Joslin patients and 73% of FinnDiane patients, those given a higher stage by eGFRcyst than eGFRcreat had a significantly higher risk of ESRD than those with concordant staging in all three cohorts (hazard ratio 2.3 [95% CI 1.8–3.1]). Similarly, patients at a lower stage by eGFRcyst than by eGFRcreat had a lower risk than those with concordant staging (0.30 [0.13–0.68]). Deaths unrelated to ESRD followed the same pattern, but differences were not as large. In patients with diabetes, CKD staging based on eGFRcyst significantly improves ESRD risk stratification based on eGFRcreat. This conclusion can be generalized to patients with type 1 and type 2 diabetes and to diabetic patients in the U.S. and Finland.
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影响因子：
13.6
作者：
Niewczas, Monika A.;Gohda, Tomohito;Krolewski, Andrzej S.
通讯作者：
Krolewski, Andrzej S.
影响因子：
13.2
作者：
Stevens, Lesley A.;Coresh, Josef;Levey, Andrew S.
通讯作者：
Levey, Andrew S.
影响因子：
39.2
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
通讯作者：
Van Lente, Frederick
影响因子：
13.6
作者：
Forsblom, Carol;Harjutsalo, Velma;Groop, Per-Henrik
通讯作者：
Groop, Per-Henrik
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)