Journal Article

DKFZ-2025-02334

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Discordance in Creatinine- and Cystatin C-Based eGFR and Clinical Outcomes: A Meta-Analysis.

Estrella, M. M. ; Ballew, S. H. ; Sang, Y. ; Grams, M. E. ; Coresh, J. ; Surapaneni, A. ; Alencar de Pinho, N. ; Ärnlöv, J. ; Brenner, H.DKFZ* ; Carrero, J.-J. ; Chen, T. K. ; Cohen, D. L. ; Cushman, M. ; Gansevoort, R. T. ; Hwang, S.-J. ; Inker, L. A. ; Ix, J. H. ; Kabasawa, K. ; Konta, T. ; Lees, J. S. ; Polkinghorne, K. R. ; Shlipak, M. G. ; Vernooij, R. W. M. ; Wheeler, D. C. ; Yadav, A. K. ; Levey, A. S. ; Eckardt, K.-U. ; Investigators, C. K. D. P. C. ; Collaborators (Collaboration Author) ; Chen, T. K. (Contributor) ; Sang, Y. (Contributor) ; Grams, M. E. (Contributor) ; Coresh, J. (Contributor) ; Chadban, S. (Contributor) ; Polkinghorne, K. (Contributor) ; Bansal, N. (Contributor) ; Ix, J. H. (Contributor) ; Shlipak, M. G. (Contributor) ; Metzger, M. (Contributor) ; Stengel, B. (Contributor) ; Landray, M. (Contributor) ; Townend, J. N. (Contributor) ; Emberson, J. (Contributor) ; Hsu, C.-Y. (Contributor) ; Yang, W. (Contributor) ; Anderson, A. (Contributor) ; Brenner, H. (Contributor)DKFZ* ; Rothenbacher, D. (Contributor) ; Schöttker, B. (Contributor)DKFZ* ; Stocker, H. (Contributor) ; Levy, D. (Contributor) ; Larson, M. (Contributor) ; Kottgen, A. (Contributor) ; Sekula, P. (Contributor) ; Schultheiss, U. T. (Contributor) ; Schneider, M. P. (Contributor) ; Kumar, V. (Contributor) ; Sahay, M. (Contributor) ; Prasad, N. (Contributor) ; Vernooij, R. W. (Contributor) ; Levey, A. S. (Contributor) ; Inker, L. A. (Contributor) ; Sarnak, M. (Contributor) ; Gutierrez, O. M. (Contributor) ; Cushman, M. (Contributor) ; Bakker, S. J. (Contributor) ; Kieneker, L. M. (Contributor) ; van Londen, M. (Contributor) ; Cheung, K. (Contributor) ; Ilori, T. (Contributor) ; Fu, E. L. (Contributor) ; Faucon, A.-L. (Contributor) ; Caldinelli, A. (Contributor) ; Creon, A. (Contributor) ; Konta, T. (Contributor) ; Ichikawa, K. (Contributor) ; Nagase, S. (Contributor) ; Watanabe, M. (Contributor) ; Lees, J. S. (Contributor) ; Mark, P. B. (Contributor) ; Larsson, A. (Contributor) ; Giedraitis, V. (Contributor) ; Kabasawa, K. (Contributor) ; Ito, Y. (Contributor) ; Tanaka, J. (Contributor) ; Narita, I. (Contributor) ; Estrella, M. (Contributor) ; Ballew, S. H. (Contributor) ; Carrero, J.-J. (Contributor) ; Gansevoort, R. T. (Contributor) ; Matsushita, K. (Contributor) ; Nitsch, D. (Contributor) ; Wang, A. Y. (Contributor) ; Flaherty, C. M. (Contributor) ; Surapaneni, A. (Contributor)

2025
American Medical Association Chicago, Ill.

Abstract: Estimated glomerular filtration rates (eGFRs) can differ according to whether creatinine or cystatin C is used for the eGFR calculation, but the prevalence and importance of these differences remain unclear.To evaluate the prevalence of a discordance between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr), identify characteristics associated with greater discordance, and evaluate associations of discordance with adverse outcomes.Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC).Participants with concurrent cystatin C and creatinine measurements and clinical outcome measurement.Between April 2024 and August 2025, data were synthesized using individual-level meta-analysis.The primary independent measurement was a large negative eGFR difference (eGFRdiff), defined as an eGFRcys that was at least 30% lower than eGFRcr. Secondary (dependent) outcomes included all-cause and cardiovascular mortality, atherosclerotic cardiovascular disease, heart failure, and kidney failure with replacement therapy.A total of 821 327 individuals from 23 outpatient cohorts (mean [SD] age, 59 [12] years; 48% female; 13.5% with diabetes; 40% with hypertension) and 39 639 individuals from 2 inpatient cohorts (mean [SD] age, 67 [16] years; 31% female; 30% with diabetes; 72% with hypertension) were included. Among outpatient participants, 11% had a large negative eGFRdiff (range, 3%-50%). Among inpatients, 35% had a large negative eGFRdiff. Among outpatient participants, at a mean (SD) follow-up of 11 (4) years, a large negative eGFRdiff, compared with an eGFRdiff between -30% and 30%, was associated with higher rates of all-cause mortality (28.4 vs 16.8 per 1000 person-years [PY]; hazard ratio [HR], 1.69 [95% CI, 1.57-1.82]), cardiovascular mortality (6.1 vs 3.8 per 1000 PY; HR, 1.61 [95% CI, 1.48-1.76]), atherosclerotic cardiovascular disease (13.3 vs 9.8 per 1000 PY; HR, 1.35 [95% CI, 1.27-1.44]), heart failure (13.2 vs 8.6 per 1000 PY; HR, 1.54 [95% CI, 1.40-1.68]), and kidney failure with replacement therapy (2.7 vs 2.1 per 1000 PY; HR, 1.29 [95% CI, 1.13-1.47]).In the CKD-PC, 11% of outpatient participants and 35% of hospitalized patients had an eGFRcys that was at least 30% lower than their eGFRcr. In the outpatient setting, presence of eGFRcys at least 30% lower than eGFRcr was associated with significantly higher rates of all-cause mortality, cardiovascular events, and kidney failure.

Note: 2025 Dec 2;334(21):1915-1926

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Contributing Institute(s):

1. C070 Klinische Epidemiologie der Krebsfrüherkennung (C070)

Research Program(s):

1. 313 - Krebsrisikofaktoren und Prävention (POF4-313) (POF4-313)

Appears in the scientific report 2025

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 90 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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