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

• Published in: Journal of epidemiology 2020-06, Vol.30 (6), p.260-267
• Main Authors: Osaki, Takuya, Satoh, Mamoru, Tanaka, Fumitaka, Tanno, Kozo, Takahashi, Yuji, Nasu, Takahito, Sakata, Kiyomi, Morino, Yoshihiro, Sobue, Kenji, Sasaki, Makoto
• Format: Article
• Language: English
• Subjects: Albumins; Biomarkers; Brain natriuretic peptide; Calcium-binding protein; Cardiovascular Disease; Cardiovascular diseases; chronic kidney disease; Creatinine; Cystatin C; Epidemiology; Glomerular filtration rate; Health risk assessment; Health risks; Heart diseases; high-sensitivity cardiac troponin t; Kidney diseases; n-terminal pro-brain natriuretic peptide; Original; Population studies; Prediction models; Reclassification; Renal function; suita score; Troponin; Troponin T; urine albumin-to-creatinine ratio
• ISSN: 0917-5040; 1349-9092
• DOI: 10.2188/jea.JE20180274

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.