Serum cystatin C as a predictor for cardiovascular events in end-stage renal disease patients at the initiation of dialysis
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- Shin, M.J., Song, S.H., Kwak, I.S. et al. Clin Exp Nephrol (2012) 16: 456. doi:10.1007/s10157-011-0583-1
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There has been no study to investigate whether cystatin C could predict cardiovascular events in incident dialysis patients. We aimed to delineate the role of serum cystatin C and cystatin C-based estimated glomerular filtration rate (eGFRcysC) for prediction of cardiovascular events.
This study included 66 end-stage renal disease patients who survived for >3 months after the start of dialysis, and serum cystain C levels were measured at the point of dialysis initiation.
Serum cystatin C was correlated with blood urea nitrogen (r = 0.537, p < 0.001), serum creatinine (r = 0.480, p < 0.001) and smoking (r = 0.284, p = 0.021). Cystatin C was inversely correlated with age (r = −0.316, p = 0.01) and eGFRCr by modification of diet in renal disease (r = −0.533, p < 0.001). Kaplan–Meier analysis for cardiovascular events revealed that patients in the group with lower cystatin C levels (<4.14 mg/L) had a better event-free survival rate than patients in the group with higher cystatin C levels (≥4.14 mg/L) (p = 0.039). In univariate analysis, cystatin C (hazard ratio (HR) 2.62, p = 0.011) and eGFRcysC (HR 0.64, p = 0.004) were significant factors for the prediction of cardiovascular events. After multivariate adjustment, serum cystatin C and eGFRcysC were independent determinants of cardiovascular events (HR 3.952, p = 0.001 and HR 0.640, p = 0.004, respectively).
Serum cystatin C might be an independent marker of cardiovascular events in incident dialysis patients. Furthermore, eGFRcysC based on measured serum cystatin C could have a new role in predicting cardiovascular events beyond the estimation of true GFR.