Background:
Adding cystatin C to serum creatinine improves accuracy of estimated glomerular filtration rate (eGFR), but the impact on detection, staging and prognosis of chronic kidney disease (CKD) across diverse populations has not been determined.
Methods:
Meta-analyses including 11 general population cohorts (N=90,750 participants) and 5 CKD cohorts (N=2,960) with standardized serum creatinine and cystatin C at baseline. We compared associations of baseline GFR estimated by CKD-EPI equations using creatinine (eGFR
cr
) vs. cystatin C (eGFR
cys
) with mortality (13,202 deaths from 15 cohorts) and incident end-stage renal disease (ESRD) (1,654 cases from 7 cohorts) during mean follow-up of 7.7 years and studied prognostic consequences of reclassification.
Results:
In the general population cohorts, mean eGFRs were 85 ml/min/1.73m
2
for both equations but prevalence of eGFR<60 ml/min/1.73m
2
was higher for eGFR
cys
vs. eGFR
cr
(13.7% vs. 9.7% [12,403 vs. 8,833 of 90,750]). Across all eGFR
cr
categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m
2
), upward and downward reclassification by eGFR
cys
was associated with lower and higher risk, respectively; net reclassification improvement for eGFR
cys
compared with eGFR
cr
was 0.23 (0.18-0.28) for mortality and 0.10 (0.00-0.21) for ESRD. Among participants with eGFR
cr
45-59 ml/min/1.73m
2
(N=6,358), ~40% were reclassified to higher eGFR
cys
categories and had lower risks of mortality (adjusted hazard ratio 0.66; 95% CI 0.57-0.77) and ESRD (0.20; 0.08-0.53) compared to those who were not reclassified. Among participants with eGFR
cr
60-89 ml/min/1.73m
2
(N=43,630), ~13% were reclassified to lower eGFR
cys
categories and had higher risk for mortality (1.57; 1.39-1.78) and ESRD (2.66; 1.52-4.67) compared to no reclassification. The results for CKD cohorts were largely similar.
Conclusions:
Cystatin C strengthens the association of eGFR with risk across diverse populations providing a potentially useful adjunct to eGFR
cr
for detection and staging of CKD.