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

ABSTRACT Introduction: Estimated glomerular filtration rate (eGFR) based on serum cystatin-C (sCys) seems as accurate as when based on serum creatinine (sCr), but sCys seems a better predictor of adverse outcomes. We aimed to study whether sCys could be a reliable tool for the prediction of adverse outcomes in elderly patients with severe chronic kidney disease (CKD). Methods: A group of 348 elderly patients with non-end-stage CKD (stages 1-4, according to eGFR-EPI sCr and/or sCys), referred to our consultation unit during 2016, was retrospectively studied and divided into four exclusive categories: CKD_stage4_neither (eGFR-sCr≥30mL/min; eGFR-sCys≥30mL/min), CKD_stage4_sCr_only (eGFR-sCr<30mL/min), CKD_stage4_sCys_only (eGFR-sCys<30mL/min) and CKD_stage4_combined (eGFRsCr<30mL/min; eGFR-sCys<30mL/min). Baseline characteristics, predictors of death, and clinical events (cardiovascular events and admissions for cardiovascular, acute kidney injury or infectious events) were explored until December 2018. Results: A 77±7.4 year-old cohort, with a modified Charlson Comorbidty Index (mCCI) of 3 (IQR:1-4), was followed-up during 29 (IQR: 26-33) months. There were no significant differences between the characteristics of the stage 4 groups. Survival analysis was stratified by follow-up at 12 months, and in the first year, survival curves of CKD_stage4_sCys_only and CKD_stage4_combined groups were significantly lower than the other groups (p=0.028). Adjusting for age, sex, and mCCI, CKD_stage4_sCys_only, conversely to CKD_stage4_sCr_only, had higher rates of clinical events (p<0.05) than CKD_stage4_neither group. Conclusion: In elderly patients with discordant CKD staging, sCys-based eGFR seems to be a better predictor of adverse outcomes than sCr-based eGFR. Patients with stage 4 CKD defined by sCr alone seem to behave similar to those with less severe CKD.

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Cystatin C is a useful predictor of early neurological deterioration following ischaemic stroke in elderly patients with normal renal function

European Stroke Journal ◽

10.1177/2396987316677197 ◽

2016 ◽

Vol 2 (1) ◽

pp. 23-30 ◽

Cited By ~ 3

Author(s):

Tae Jung Kim ◽

Min Kyoung Kang ◽

Han-Gil Jeong ◽

Chi Kyung Kim ◽

Yerim Kim ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Elderly Patients ◽

Ischaemic Stroke ◽

Acute Stroke ◽

Cystatin C ◽

Acute Ischaemic Stroke ◽

Neurological Deterioration ◽

Early Neurological Deterioration

Introduction Cystatin C has been suggested as a sensitive marker of renal function. A high level of cystatin C is related to cardiovascular disease and stroke in elderly patients. We investigated the relationship between levels of cystatin C and early neurological deterioration with acute ischaemic stroke in elderly patients without chronic kidney disease. Patients and methods We evaluated a total of 771 elderly patients (mean age, 72.2; male, 59.0%) without chronic kidney disease who were admitted following acute ischaemic stroke between March 2010 and January 2015. The patients were divided into four groups based on the quartiles of serum cystatin C values. Early neurological deterioration was defined as an increase of ≥2 points from the baseline National Institutes of Health Stroke Scale score during the 7 days following onset. We compared the clinical characteristics and cystatin C concentrations between patients with and without early neurological deterioration. Results Eighty-six patients (11.2%) experienced early neurological deterioration. The percentage values of the higher (third and fourth) quartiles were significantly higher in the early neurological deterioration group (30.2% vs. 24.4% and 34.9% vs. 23.8%, P = 0.002). After adjustment for covariates, higher cystatin C levels were independently associated with a higher risk of early neurological deterioration: odds ratio (95% confidence interval) for second quartile 1.59 (0.70–3.58), third quartile 2.75 (1.25–6.04), fourth quartile 3.12 (1.36–7.16); P for trend 0.026. Discussion and conclusions This study demonstrated that cystatin C concentrations in elderly patients without chronic kidney disease were associated with early neurological deterioration following acute stroke. This suggests that cystatin C level could be a useful predictor for early neurological deterioration following acute stroke.

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Risk factors for high fall risk in elderly patients with chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-021-02884-w ◽

2021 ◽

Author(s):

Cihan Heybeli ◽

Rumeyza Kazancioglu ◽

Lee Smith ◽

Nicola Veronese ◽

Pinar Soysal

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Fall Risk

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The Search for a New Marker of Renal Function in Older Patients with Chronic Kidney Disease Stages 3–4: Usefulness of Cystatin C-Based Equations

Nephron Clinical Practice ◽

10.1159/000214212 ◽

2009 ◽

Vol 112 (3) ◽

pp. c164-c170 ◽

Cited By ~ 6

Author(s):

Néstor Fontseré ◽

Vicens Esteve ◽

Ana Saurina ◽

Mónica Pou ◽

Nuria Barba ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Cystatin C ◽

Older Patients ◽

Disease Stages

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CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equation seems more suitable for Chinese patients with chronic kidney disease than other equations

BMC Nephrology ◽

10.1186/s12882-017-0637-z ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Xiao-Hua Chi ◽

Gui-Ping Li ◽

Quan-Shi Wang ◽

Yong-Shuai Qi ◽

Kai Huang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Glomerular Filtration ◽

Cystatin C ◽

Filtration Rate ◽

Chinese Patients ◽

Rate Estimation ◽

Glomerular Filtration Rate Estimation

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FEATURES OF CHRONIC KIDNEY DISEASE IN ELDERLY PATIENTS

Успехи геронтологии ◽

10.34922/ae.2020.33.1.015 ◽

2020 ◽

pp. 113-120

Author(s):

О. Н. Курочкина

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Clinical Situation ◽

Chronic Glomerulonephritis ◽

Hypertensive Nephropathy ◽

Number Of Patients ◽

Rate Of Decline ◽

People Group ◽

Group 1

Изучены особенности течения хронической болезни почек (ХБП) у пожилых пациентов на основании анализа регистра ХБП за 2015-2018 гг. В регистре 484 пациента, из них 231 (47,7%) мужчина, 253 (52,3%) женщины, средний возраст - 58,8±15,8 года. Пациенты были разделены на три группы: 1-я - 218 человек до 59 лет; 2-я - 207 человек 60-74 лет; 3-я - 59 человек 75 лет и старше. В 1-й группе ведущей причиной ХБП явился хронический гломерулонефрит -27,1%, во 2-й - хронический тубулоинтерстициальный нефрит (ТИН) - 21,7%, диабетическая нефропатия (ДН) - 20,8% и гипертоническая нефропатия - 15,9%; в 3-й - ТИН (27,1%), хронический пиелонефрит (ПН) - 15,9% и ДН (13,6%). С возрастом увеличивалась частота встречаемости ТИН ( р <0,1), ПН ( р <0,05), ишемической болезни почек ( р <0,05), подагрической нефропатии ( р <0,1). Среднее снижение СКФ - 3,99 мл/мин на 1,73 мза год наблюдения. Темп снижения СКФ в 1-й группе - 3,36±1,8 мл/мин на 1,73 мза год, во 2-й - 2,43±1,2 ( р <0,001 между 1-йи 2-й группой), в 3-й - 1,82±1,1 мл/мин на 1,73 мза год. Наблюдали отрицательную корреляцию с возрастом ( р <0,05). Формирование регистра больных с ХБП позволяет знать количество больных и причины ХБП у пациентов пожилого и старческого возраста, оценивать клиническую ситуацию, темпы снижения СКФ и выбирать лечебную тактику у этих пациентов. The purpose of the work is to study the characteristics of the course of chronic kidney disease in elderly patients based on the analysis of the register of chronic kidney disease (CKD) for 2015-2018. in the Department of Nephrology, the Komi Republican Clinical Hospital. There are 484 patients in the register, of whom 231 are men (47,7%), 253 women (52,3%). The average age is 58,8±15,8 years old. The patients were divided into 3 groups: persons under the age of 59 years old - 218 people (group 1); from 60 to 74 years old - 207 people (group 2); and over 75 years old - 59 people (group 3). Most patients are between the ages of 60 and 69 years old. In the 1 group, the chronic glomerulonephritis is the leading cause of CKD - 27,1%; in the 2 group - the chronic tubulo-interstitial nephritis (TIN) - 21,7%, the diabetic nephropathy (DN) - 20,8% and the hypertensive nephropathy - 15,9%; in the 3 group - TIN (27,1%), the chronic pyelonephritis (PN) (15,9%) and DN (13,6%). With increasing age, the incidence of TIN ( p <0,1), MO ( p <0,05), coronary kidney disease (IBP) ( p <0,05), gouty nephropathy ( p <0,1) were raised. The average reduction in GFR is 3,99 ml/min/1,73 m per year of observation. The rate of decline in GFR in the 1st group is 3,36±1,8 ml/min/1,73 m per year, in the 2 - 2,43±1,2 ( p <0,001 between group 1 and 2), in the 3 group - 1,82±1,1; with aging the negative correlation was observed ( p <0,05). 39 patients received hemodialysis, including: in the 1 group - 20 people (9%), in the 2 group - 18 (8,7%), in the 3 group - 1 patient (1,7%). Making the register of the patients with CKD allows us to know the number of patients and the causes of CKD among the patients of elderly and senile ages, to assess the clinical situation, the rate of decline in GFR and treatment tactics in these patients.

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