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@ARTICLE{Rothenbacher:165843,
      author       = {D. Rothenbacher$^*$ and M. Rehm and L. Iacoviello and S.
                      Costanzo and H. Tunstall-Pedoe and J. J. F. Belch and S.
                      Söderberg and J. Hultdin and V. Salomaa and P. Jousilahti
                      and A. Linneberg and S. Sans and T. Padró and B. Thorand
                      and C. Meisinger and F. Kee and A. J. McKnight and T.
                      Palosaari and K. Kuulasmaa and C. Waldeyer and T. Zeller and
                      S. Blankenberg and W. Koenig},
      collaboration = {B. consortium},
      title        = {{C}ontribution of cystatin {C}- and creatinine-based
                      definitions of chronic kidney disease to cardiovascular risk
                      assessment in 20 population-based and 3 disease cohorts: the
                      {B}iomar{C}a{RE} project.},
      journal      = {BMC medicine},
      volume       = {18},
      number       = {1},
      issn         = {1741-7015},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer},
      reportid     = {DKFZ-2020-02419},
      pages        = {300},
      year         = {2020},
      note         = {#EA:C070#},
      abstract     = {Chronic kidney disease has emerged as a strong
                      cardiovascular risk factor, and in many current guidelines,
                      it is already considered as a coronary heart disease (CHD)
                      equivalent. Routinely, creatinine has been used as the main
                      marker of renal function, but recently, cystatin C emerged
                      as a more promising marker. The aim of this study was to
                      assess the comparative cardiovascular and mortality risk of
                      chronic kidney disease (CKD) using cystatin C-based and
                      creatinine-based equations of the estimated glomerular
                      filtration rate (eGFR) in participants of population-based
                      and disease cohorts.The present study has been conducted
                      within the BiomarCaRE project, with harmonized data from 20
                      population-based cohorts (n = 76,954) from 6 European
                      countries and 3 cardiovascular disease (CVD) cohorts (n =
                      4982) from Germany. Cox proportional hazards models were
                      used to assess hazard ratios (HRs) for the various CKD
                      definitions with adverse outcomes and mortality after
                      adjustment for the Systematic COronary Risk Evaluation
                      (SCORE) variables and study center. Main outcome measures
                      were cardiovascular diseases, cardiovascular death, and
                      all-cause mortality.The overall prevalence of CKD stage 3-5
                      by creatinine- and cystatin C-based eGFR, respectively, was
                      $3.3\%$ and $7.4\%$ in the population-based cohorts and
                      $13.9\%$ and $14.4\%$ in the disease cohorts. CKD was an
                      important independent risk factor for subsequent CVD events
                      and mortality. For example, in the population-based cohorts,
                      the HR for CVD mortality was 1.72 $(95\%$ CI 1.53 to 1.92)
                      with creatinine-based CKD and it was 2.14 $(95\%$ CI 1.90 to
                      2.40) based on cystatin-based CKD compared to participants
                      without CKD. In general, the HRs were higher for cystatin
                      C-based CKD compared to creatinine-based CKD, for all three
                      outcomes and risk increased clearly below the conventional
                      threshold for CKD, also in older adults. Net
                      reclassification indices were larger for a cystatin-C based
                      CKD definition. Differences in HRs (between the two CKD
                      measures) in the disease cohorts were less pronounced than
                      in the population-based cohorts.CKD is an important risk
                      factor for subsequent CVD events and total mortality.
                      However, point estimates of creatinine- and cystatin C-based
                      CKD differed considerably between low- and high-risk
                      populations. Especially in low-risk settings, the use of
                      cystatin C-based CKD may result in more accurate risk
                      estimates and have better prognostic value.},
      cin          = {C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {323 - Metabolic Dysfunction as Risk Factor (POF3-323)},
      pid          = {G:(DE-HGF)POF3-323},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33161898},
      doi          = {10.1186/s12916-020-01776-7},
      url          = {https://inrepo02.dkfz.de/record/165843},
}