Association of Intra-individual Differences in Estimated GFR by Creatinine Versus Cystatin C With Incident Heart Failure.
Association of Intra-individual Differences in Estimated GFR by Creatinine Versus Cystatin C With Incident Heart Failure.
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DOI：
10.1053/j.ajkd.2022.05.011
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发表时间：
2022-12
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影响因子：
--
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较低的估计肾小球滤过率（eGFR）与心力衰竭（HF）风险相关。然而，基于胱抑素C（eGFRcys）和肌酐（eGFRcr）的eGFR在个体内可能存在显著差异。这些差异对慢性肾脏病（CKD）患者HF风险的临床意义尚不清楚。前瞻性队列研究。4，512名患有CKD且无HF的成年人参加了慢性肾功能不全队列（CRIC）研究。eGFRdiffcys-cr（eGFRcys减去eGFRcr）。HF住院事件。采用Fine-Gray比例子危险回归分析研究基线、时间更新和eGFRdiffcys-cr斜率与HF事件的相关性。在4，512名参与者中，三分之一的eGFRcys和eGFRcr值相差超过15 mL/min/1.73 m。在多变量校正模型中，基线eGFRdiffcys-cr每降低15 mL/min/1.73 m与HF住院事件风险升高相关（风险比[HR]=1.20; 95% CI：1.07-1.34）。在时间更新分析中，与eGFRcys和eGFRcr相似的受试者相比，eGFRdiffcys-cr < −15的受试者发生HF住院的风险较高（HR=1.99; 95% CI：1.39-2.86），eGFRdiffcys-cr ≥15的受试者发生HF住院的风险较低（HR=0.67; 95% CI：0.49-0.91）。与eGFRcys和eGFRcr平行下降的受试者相比，eGFRcys相对于eGFRcr下降更快的受试者发生HF的风险更高（HR=1.49; 95% CI：1.19-1.85）。根据eGFRcr确定是否进入CRIC研究，这限制了基线eGFRcr的范围，但不限制eGFRcys值的范围。在eGFRcys和eGFRcr之间存在较大差异的CKD患者中，HF事件的风险与eGFRcys的相关性更强。eGFRcys和eGFRcr随时间推移的斜率差异也与HF事件风险独立相关。肾功能较低的个体，如通过估计的肾小球滤过率（eGFR）确定的，有更高的发生心力衰竭（HF）的风险。胱抑素C和肌酐都是用于确定eGFR的生物标志物。然而，在一个个体内，基于半胱氨酸蛋白酶抑制剂C的eGFR（eGFRcys）可能与基于肌酸酐的eGFR（eGFRcr）有很大差异。当这些差异（eGFR diffcys-cr）较大时，哪种eGFR指标是HF风险的更可靠指标尚不清楚。我们在一个非卧床CKD队列中分析了eGFRdiffcys-cr与HF发生风险的关系。在eGFRcys和eGFRcr之间存在较大差异的参与者中，eGFRcys与HF事件风险的相关性更强。评价eGFRcys、eGFRcr及其差异可以优化CKD患者的HF风险评估。
Lower estimated glomerular filtration rate (eGFR) is associated with heart failure (HF) risk. However, eGFR based on cystatin C (eGFRcys) and creatinine (eGFRcr) may differ substantially within an individual. The clinical implications of these differences for risk of HF among persons with chronic kidney disease (CKD) are unknown. Prospective cohort study. 4,512 adults with CKD and without prevalent HF who enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. eGFRdiffcys-cr (eGFRcys minus eGFRcr). Incident HF hospitalization. Fine-Gray proportional subhazards regression was used to investigate the associations of baseline, time-updated, and slope of eGFRdiffcys-cr with incident HF. Of 4,512 participants, one-third had eGFRcys and eGFRcr values that differed by over 15 mL/min/1.73 m. In multivariable-adjusted models, each 15 mL/min/1.73 m lower baseline eGFRdiffcys-cr was associated with higher risk of incident HF hospitalization (hazard ratio [HR]=1.20; 95% CI: 1.07-1.34). In time-updated analyses, those with eGFRdiffcys-cr < −15 had higher risk of incident HF hospitalization (HR=1.99; 95% CI: 1.39-2.86) and those with eGFRdiffcys-cr ≥15 had lower risk of incident HF hospitalization (HR=0.67; 95% CI: 0.49-0.91) compared to participants with similar eGFRcys and eGFRcr. Participants with faster declines in eGFRcys relative to eGFRcr had higher risk of incident HF (HR=1.49; 95% CI: 1.19-1.85) compared with those in whom eGFRcys and eGFRcr declined in parallel. Entry into the CRIC Study was determined by eGFRcr, which constrained the range of baseline eGFRcr but not of eGFRcys values. Among persons with CKD who have large differences between eGFRcys and eGFRcr, risk for incident HF is more strongly associated with eGFRcys. Diverging slopes between eGFRcys and eGFRcr over time are also independently associated with risk of incident HF. Individuals with lower kidney function, as determined by estimated glomerular filtration rate (eGFR), have higher risk of developing heart failure (HF). Cystatin C and creatinine are both biomarkers used to determine eGFR. However, cystatin C-based eGFR (eGFRcys) may differ substantially from creatinine-based eGFR (eGFRcr) within one individual. When these differences, eGFRdiffcys-cr, are large, which eGFR measure is a more reliable indicator of HF risk is unclear. We analyzed the association of eGFRdiffcys-cr, with risk of incident HF among an ambulatory CKD cohort. Among participants who have large differences between eGFRcys and eGFRcr, eGFRcys was more strongly associated with risk of incident HF . Evaluating both eGFRcys, eGFRcr, and their difference can optimize HF risk assessment among persons with CKD.
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DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
DOI：
10.2215/cjn.02870313
发表时间：
2013-12-06
影响因子：
9.8
作者：
Dalrymple, Lorien S.;Katz, Ronit;Shlipak, Michael G.
通讯作者：
Shlipak, Michael G.
DOI：
10.1093/biostatistics/1.4.465
发表时间：
2000-12-01
期刊：
Biostatistics (Oxford, England)
影响因子：
--
作者：
Henderson, R;Diggle, P;Dobson, A
通讯作者：
Dobson, A
影响因子：
39.2
作者：
Anderson AH;Yang W;Townsend RR;Pan Q;Chertow GM;Kusek JW;Charleston J;He J;Kallem R;Lash JP;Miller ER 3rd;Rahman M;Steigerwalt S;Weir M;Wright JT Jr;Feldman HI;Chronic Renal Insufficiency Cohort Study Investigators
通讯作者：
Chronic Renal Insufficiency Cohort Study Investigators
DOI：
10.1053/j.ajkd.2013.05.022
发表时间：
2014-01
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Ensrud KE;Parimi N;Fink HA;Ishani A;Taylor BC;Steffes M;Cauley JA;Lewis CE;Orwoll ES;Osteoporotic Fractures in Men Study Group
通讯作者：
Osteoporotic Fractures in Men Study Group