Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-Creatinine Ratio and Association With Progression to End-Stage Renal Disease and Mortality

• Published in: JAMA : the journal of the American Medical Association 2011-04, Vol.305 (15), p.1545-1552
• Main Authors: Peralta, Carmen A, Shlipak, Michael G, Judd, Suzanne, Cushman, Mary, McClellan, William, Zakai, Neil A, Safford, Monika M, Zhang, Xiao, Muntner, Paul, Warnock, David
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Albuminuria - urine; Biological and medical sciences; Biomarkers; Biomarkers - analysis; Cause of Death; Creatinine - blood; Cystatin C - blood; Disease Progression; Female; Forecasting; General aspects; Glomerular Filtration Rate; Humans; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - pathology; Kidney Failure, Chronic - urine; Kidneys; Male; Medical sciences; Middle Aged; Molecules; Mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Older people; Predictive Value of Tests; Prognosis; Prospective Studies; Proteins; Renal failure; Risk; Urinary system involvement in other diseases. Miscellaneous
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2011.468

CONTEXT A triple-marker approach for chronic kidney disease (CKD) evaluation has not been well studied. OBJECTIVE To evaluate whether combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) would improve identification of risks associated with CKD compared with creatinine alone. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study involving 26 643 US adults enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from January 2003 to June 2010. Participants were categorized into 8 groups defined by estimated glomerular filtration rate (GFR) determined by creatinine and by cystatin C of either