FP280THE ROLE OF CYSTATIN C AND CYSTATIN C-BASED GFR MARKERS FOR PREDICTION OF MORTALITY IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASE

BackgroundIt remains uncertain whether cystatin C is a superior marker of renal function than creatinine in older adults. We have investigated the association between estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on creatinine (CKD-EPIcr) and cystatin C (CKD-EPIcys), and cardiovascular risk markers and mortality in older adults.MethodsThis is a cross-sectional and prospective study of 1639 British men aged 71–92 years followed up for an average of 5 years for mortality. Cox survival model and receiving operating characteristic analysis were used to assess the associations.ResultsThe prevalence of chronic kidney disease (CKD) was similar using the two CKD-EPI equations, although cystatin C reclassified 43.9% of those with stage 3a CKD (eGFR 45–59 mL/min/1.732, moderate damage) to no CKD. However, CKD stages assessed using both CKD-EPIcr and CKD-EPIcys were significantly associated with vascular risk markers and with all-cause and cardiovascular disease mortality. In all men with CKD (eGFR <60 mL/min/1.732), the HRs (95% CI) for all-cause mortality after adjustment for cardiovascular risk factors compared with those with no CKD were 1.53 (1.20 to 1.96) and 1.74 (1.35 to 2.23) using CKD-EPIcr and CKD-EPIcys, respectively. Comparisons of the two CKD equations showed no significant difference in their predictive ability for mortality (difference in area under the curve p=0.46).ConclusionDespite reclassification of CKD stages, assessment of CKD using CKD-EPIcys did not improve prediction of mortality in older British men >70 years. Our data do not support the routine use of CKD-EPIcys for identifying CKD in the elderly British male population.

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The role of cystatin C in the risk of hip fractures in the elderly

Journal of Research and Practice on the Musculoskeletal System ◽

10.22540/jrpms-04-108 ◽

2020 ◽

Vol 4 (4) ◽

pp. 108-112

Author(s):

Konstantina Papakonstantinopoulou ◽

Ioannis Sofianos

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Fracture Risk ◽

Cystatin C ◽

Hip Fractures ◽

The Elderly ◽

Elder Patients ◽

Severe Chronic Kidney Disease ◽

Fracture Risk Prediction

World’s population is aging. The elderly are at high risk for both chronic kidney disease (CKD) and hip fractures. Severe chronic kidney disease is a well-known risk factor for fractures and death especially in the elderly. Mild and moderate stages of kidney disease are often undiagnosed and/or untreated, thus their effect on fracture risk is not well established. Many ways of estimating glomerular filtration rate (GFR) have been developed but there are very few studies recommending the best and most valuable method for estimated GFR (eGFR) calculation that could correlate with fracture risk. In this mini- review we searched the literature concerning the use of cystatin C in the estimation of GFR related to the risk of hip fractures in the elderly. Our goal was to review the most important recent evidence on whether cystatin C could become a useful biomarker for the prediction of fracture risk. We concluded that there is evidence to support the use of cystatin C in hip fracture risk prediction in elder patients with chronic kidney disease.

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Population Pharmacokinetic Analysis and Dosing Optimization Based on Unbound Daptomycin Concentration and Cystatin C in Nonobese Elderly Patients with Hypoalbuminemia and Chronic Kidney Disease

Pharmaceutical Research ◽

10.1007/s11095-021-03058-0 ◽

2021 ◽

Author(s):

Masaru Samura ◽

Keisuke Takada ◽

Risako Yamamoto ◽

Hayato Ito ◽

Fumio Nagumo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Cystatin C ◽

Population Pharmacokinetic Analysis ◽

Pharmacokinetic Analysis ◽

Population Pharmacokinetic ◽

Dosing Optimization

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Association between severe chronic kidney disease defined by cystatin-c and creatinine and clinical outcomes in an elderly population - an observational study

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2020-0092 ◽

2020 ◽

Author(s):

Joana Tavares ◽

Josefina Santos ◽

Filipa Silva ◽

João Oliveira ◽

Jorge Malheiro ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Cystatin C ◽

Kidney Injury ◽

Adverse Outcomes ◽

Serum Cystatin C ◽

Clinical Events ◽

Stage 4 ◽

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

The Aging Male ◽

10.1080/13685538.2018.1479386 ◽

2018 ◽

Vol 22 (1) ◽

pp. 62-67 ◽

Cited By ~ 3

Author(s):

Sebastjan Bevc ◽

Nina Hojs ◽

Maša Knehtl ◽

Robert Ekart ◽

Radovan Hojs

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Cystatin C

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Role of Serum Uromodulin in the Early Diagnosis of Chronic Kidney Disease

Acta Medica Bulgarica ◽

10.2478/amb-2021-0002 ◽

2021 ◽

Vol 48 (1) ◽

pp. 13-16

Author(s):

D. Genov ◽

A. Kundurdgiev ◽

I. Ivanova ◽

M. Nikolova ◽

V. Pencheva ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Early Diagnosis ◽

Renal Impairment ◽

Serum Creatinine ◽

Cystatin C ◽

Inverse Correlation ◽

Abdominal Ultrasound ◽

University Hospital

Abstract Background: The diagnosis of chronic kidney disease (CKD) is usually delayed, when significant functional renal impairment has already occurred. The diagnosis is complex and clinical and laboratory investigations play a crucial role. There are well-established markers of CKD – serum creatinine and cystatin C. However, the search for new reliable biomarkers that aid in the assessment of kidney function and predict the evolution of the disease is still in progress. Objective: To investigate the role of serum uromodulin (sUmod) as a marker for early diagnosis of renal impairment in patients with CKD. Materials and Methods: We investigated 70 patients, 28 male and 42 female, mean age 56.53 ± 11.753, with CKD in a prospective observational study. All patients were admitted to the Clinic of Nephrology at the “St. Ivan Rilski” University Hospital between April and November 2019. After obtaining written informed consent, laboratory blood and urine tests, abdominal ultrasound and sUmod investigations were performed in all patients. Results: Plasma uromodulin levels showed decrease with the increasing of the severity of renal impairment. sUmod displayed inverse correlation with serum creatinine (r = -0.467, p < 0.0001), cystatin C (r = -0.430, p < 0.0001) and urea (r = -0.495, p < 0.0001) and a positive correlation with eGFR (r = 0.628, p < 0.0001). Conclusion: The results of our study show that sUmod levels significantly correlate with all established laboratory parameters used for the evaluation of renal impairment. It can be used as a potential early biomarker for CKD diagnosis.

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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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Potential effect of pharmaceutical care to improve outcomes in patients with chronic kidney disease-mineral bone disorder in Sulaimani dialysis centers

Al Mustansiriyah Journal of Pharmaceutical Sciences ◽

10.32947/ajps.20.01.0442 ◽

2020 ◽

pp. 82-94

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Pharmaceutical Care ◽

Biochemical Parameters ◽

Positive Impact ◽

Potential Effect ◽

Care Group ◽

Mineral Bone Disorder ◽

Bone Disorder

Objective: the present study was aimed to evaluate the role of pharmaceutical services in improving the outcome of mineral bone disorder in patients with advanced chronic kidney disease. Methodology: One hundred and twenty patients with chronic kidney disease-mineral bone disorder (CKD-MBD) screened for eligibility, seventy-six patients enrolled in the study and randomly allocated into two groups: pharmaceutical care and usual care, both groups interviewed by the pharmacist using specific questionnaire for assessing the quality of life (QoL). All the drug related problems (DRPs) including drug-drug interactions (DDIs) were recorded by the pharmacist. Blood samples were collected and utilized for analyzing the levels of vitamin D, phosphorous, calcium, albumin and parathyroid hormone at baseline and three months after. The pharmaceutical care group received all the educations about their medications and how to minimize DRPs; improve the QoL. Additionally, the pharmaceutical intervention included correcting the biochemical parameters. Results: Pharmaceutical care significantly improved patients QoL and minimized DRPs and DDIs. It was also effective in improving the biochemical parameters. Conclusion: Pharmaceutical care has a positive impact on improving the outcome of patients with CKD-MBD through attenuating DRPs, improving the biochemical parameters and the QoL.

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