目的:当基于肌酐(eGFRcr)的估算值对于临床决策不够准确时,建议使用胱抑素C来估算肾小球滤过率(eGFR)。虽然全球采用缓慢,在瑞典常规的胱抑素C检测已经有十多年了,提供有关eGFRcys和eGFRcr之间差异的大小及其与临床结局的关联的真实世界证据。
方法:观察性研究。
方法:158,601名成年人(48%为女性,平均62年,eGFRcr80和eGFRcys73ml/min/1.73/m2)在同一天接受肌酐和胱抑素C的测试,与2010-2018年在斯德哥尔摩的一次医疗保健会议有关,瑞典。
方法:eGFRcys减去eGFRcr的百分比差异(eGFRdiffcys-cr)。
结果:替代疗法(KFRT)肾功能衰竭,急性肾损伤(AKI),动脉粥样硬化性心血管疾病(ASCVD),心力衰竭(HF)和死亡。
方法:多变量Cox比例风险回归。
结果:eGFRcr和eGFRcy之间的不一致是常见的,在大多数情况下,eGFRcys低于eGFRcr(阴性eGFRdiffcys-cr)(65%)。eGFRdiffcys-cr阴性的患者年龄较大,更多的是女性,较高的eGFRcr和蛋白尿,和更多的合并症。与eGFRcys和eGFRcr相似的患者相比,在所有研究结局中,最低四分位数(eGFRcr>27%)的风险比(HR)较高(AKIHR2.6;95%CI2.4-2.9,KFRT1.4;1.2-1.6,ASCVD1.4;1.3-1.5,HF2.0;1.9-2.2和全因死亡2.6;2.5-2.7).相反,位于最高四分位数(eGFRdiffcys-cr阳性)的患者风险较低.
结论:观察性研究,缺乏关于胱抑素C测试适应症的信息。
结论:常规护理中的胱抑素C检测表明,许多患者的eGFRcr低于eGFRcr,这些患者出现多种不良结局的风险较高.
OBJECTIVE: Cystatin C is recommended for measuring estimated glomerular filtration rate (eGFR) when estimates based on creatinine (eGFRcr) are not thought to be accurate enough for clinical decision making. While global adoption is slow, routine cystatin C testing in Sweden has been available for over a decade, providing real-world evidence about the magnitude of differences between eGFRcys and eGFRcr and their association with clinical outcomes.
METHODS: Observational study.
METHODS: 158,601 adults (48% women; mean age 62 years, eGFRcr 80, and eGFRcys 73mL/min/1.73/m2) undergoing testing for creatinine and cystatin C on the same day in connection with a health care encounter during 2010-2018 in Stockholm, Sweden.
METHODS: Percentage difference of eGFRcys minus eGFRcr (eGFRdiff).
RESULTS: Kidney failure with replacement therapy (KFRT), acute kidney injury (AKI), atherosclerotic cardiovascular disease (ASCVD), heart failure, and death.
METHODS: Multivariable Cox proportional hazards regression.
RESULTS: Discordances between eGFRcr and eGFRcys were common, with eGFRcys being lower than eGFRcr (negative eGFRdiff) in most cases (65%). Patients with larger negative eGFRdiff were older, more often female, with higher eGFRcr and albuminuria, and more comorbid conditions. Compared with patients with similar eGFRcys and eGFRcr, the lowest quartile (eGFRcys > 27% lower than eGFRcr) had the higher HR of all study outcomes: AKI, 2.6 (95% CI, 2.4-2.9); KFRT, 1.4 (95% CI, 1.2-1.6); ASCVD, 1.4 (95% CI, 1.3-1.5); heart failure, 2.0 (95% CI, 1.9-2.2); and all-cause death, 2.6 (95% CI, 2.5-2.7). Conversely, patients in the highest quartile (positive eGFRdiff) were at lower risk.
CONCLUSIONS: Observational study, lack of information on indications for cystatin C testing.
CONCLUSIONS: Cystatin C testing in routine care shows that many patients have a lower eGFRcys than eGFRcr, and these patients have a higher risk of multiple adverse outcomes.
UNASSIGNED: Clinicians require guidance when there are discrepancies between the estimated glomerular filtration rate based on creatinine (eGFRcr) and based on cystatin C (eGFRcys) in the same individual. Routine cystatin C testing in Sweden for over a decade permits exploration of how common and large these discrepancies are, and their associations with adverse clinical outcomes. In this observational study, we found that discordances between eGFRcys and eGFRcr are common, and 1 in 4 patients tested had an eGFRcys > 28% lower than their eGFRcr. We also show that an eGFRcys that is lower than the eGFRcr consistently identifies patients at higher risk of adverse outcomes, including cardiovascular events, kidney replacement therapy, acute kidney injury, and death.