4.6 Article

Serum creatinine to cystatin C ratio and clinical outcomes in adults with non-dialysis chronic kidney disease

Journal

FRONTIERS IN NUTRITION
Volume 9, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fnut.2022.996674

Keywords

creatinine; cystatin C ratio; death; cardiovascular events; chronic kidney disease; muscle wasting

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This study found that a higher serum creatinine/cystatin C ratio is associated with a lower risk of adverse outcomes, especially all-cause mortality, in non-dialysis chronic kidney disease (CKD) patients, even after adjusting for estimated glomerular filtration rate (eGFR). Therefore, the serum creatinine/cystatin C ratio can be considered a useful prognostic marker in CKD patients.
BackgroundStudies have suggested that the serum creatinine/cystatin C (Cr/CysC) ratio is a surrogate marker for muscle wasting is associated with adverse outcomes in several disease conditions. To clarify the utility of the Cr/CysC ratio as a prognostic marker in chronic kidney disease (CKD) we evaluated the association between the Cr/CysC ratio clinical outcomes in patients with non-dialysis CKD. MethodsThis prospective observational cohort study included 1,966 participants of the KoreaN cohort study Outcomes in patients With CKD (KNOW-CKD). We evaluated associated factors with the serum Cr/CysC ratio and association between the serum Cr/CysC ratio and composite outcomes of all-cause death and cardiovascular events (CVEs). ResultsThe mean age was 54 +/- 12 (SD) years and 61% were men. The mean serum Cr/CysC ratio was 10.97 +/- 1.94 in men and 9.10 +/- 1.77 in women. The Cr/CysC ratio correlated positively with urinary creatinine excretion, a marker of muscle mass. In the fully adjusted Cox proportional hazard model, the Cr/CysC ratio was associated with the occurrence of adverse outcomes through a median follow-up of 5.9 years [hazard ratio (HR) = 0.92, 95% confidence interval (CI) = 0.85-0.99 for the composite outcomes, HR = 0.87, 95% CI, 0.78 - 0.97 for all-cause death, and HR = 0.93; 95% CI, 0.84-1.04 for CVEs]. In subgroup analyses, there were interactions of the Cr/CysC ratio with age and sex for risk of the clinical outcomes, but not eGFR group. ConclusionA higher Cr/CysC ratio is associated with a lower risk of the composite outcomes, especially all-cause mortality, even after adjusting for eGFR. These suggest that the Cr/CysC ratio is a useful prognostic marker in CKD.

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