Cystatin C as a predictor of mortality in elderly patients with chronic kidney disease

Abstract

Background: The prevalence of chronic kidney disease (CKD) in the elderly is high. Serum cystatin C is an accurate marker of kidney function and it also has prognostic utility in CKD patients. The aim of our study was to determine the prediction of serum cystatin C and other markers of kidney function on long-term survival in elderly CKD patients.

Methods: Fifty eight adult Caucasian patients, older than 65 years, without known malignancy, thyroid disease and/or not on steroid therapy were enrolled in the study. In each patient, ⁵¹CrEDTA clearance, serum creatinine, serum cystatin C, and estimated glomerular filtration rate using different equations were determined on the same day and patients were then followed for 11 years or until their death.

Results: The means are as follows: ⁵¹CrEDTA clearance 53.3 ± 17.4 ml/min/1.73 m², serum creatinine 1.62 ± 0.5 mg/dl, serum cystatin C 1.79 ± 0.5 mg/l, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation 40.1 ± 14 ml/min/1.73 m², Berlin Initiative Study 2 (BIS2) equation 38.9 ± 10.7 ml/min/1.73 m², full age spectrum (FAS) creatinine equation 43.8 ± 13.8 ml/min/1.73 m², FAS cystatin C equation 40.1 ± 11.7 ml/min/1.73 m². In the follow up period, 47 (81%) patients died. Cox regression analysis showed different hazard ratios (HRs) for death: for ⁵¹CrEDTA clearance HR 1.022 (95% CI 1.004–1.042; p = .015), serum creatinine HR 1.013 (95% CI 1.006–1.019; p = .001), serum cystatin C HR 2.028 (95% CI 1.267–3.241; p = .003), CKD-EPI creatinine equation HR 1.048 (95% CI 1.019–1.076; p = .001), BIS2 equation HR 1.055 (95% CI 1.021–1.088; p = .001), FAS creatinine equation HR 1.046 (95% CI 1.017–1.074; p = .001), FAS cystatin C equation HR 1.039 (95% CI 1.010–1.071; p = .009).

Conclusions: Our results showed the highest HR for serum cystatin C among kidney function markers for prediction of outcome in elderly CKD patients.

Keywords:

• Serum cystatin C
• glomerular filtration rate estimation equations
• ⁵¹CrEDTA clearance
• elderly CKD patients
• mortality

Ethical approval

The Slovenian National Medical Ethics Committee approved the protocols in this study (approval no. 29/02/08).

Acknowledgements

The results presented in this paper have been accepted for poster presentation at the American Society of Nephrology Kidney week 2017 Annual Meeting, October 31–November 5 in New Orleans, LA.

Informed consent

The informed consent was obtained from every patient.

Disclosure statement

The authors have declared that no conflict of interest exists.