Centers for Disease Control and Prevention, Atlanta, GA, USA.
Am J Kidney Dis. 2013 Jul;62(1):33-41. doi: 10.1053/j.ajkd.2012.11.044. Epub 2013 Jan 21.
We compared values of baseline serum cystatin C (SCysC), serum creatinine (SCr), and measured glomerular filtration rate (mGFR) for predicting end-stage renal disease (ESRD) in patients with type 2 diabetes and elevated albuminuria.
Observational longitudinal study.
SETTING & PARTICIPANTS: Pima Indians with type 2 diabetes and elevated albumin-creatinine ratio (ACR ≥30 mg/g).
Baseline SCysC, SCr, and mGFR.
OUTCOMES & MEASUREMENTS: Individuals were followed up from their first examination with diabetes and ACR ≥30 mg/g until December 2010, onset of ESRD, or death, whichever came first. Incidence rates adjusted for age and sex were computed by Mantel-Haenszel stratification. The abilities of SCysC, SCr, and mGFR values to predict ESRD were compared with receiver operating characteristic curves.
Of 234 Pima Indians with a mean age of 42.8 years who were followed up for a median of 10.7 (range, 0.6-21.3) years, 68 (29%) developed ESRD. The incidence of ESRD was significantly higher in patients in the lowest versus highest tertile of 1/SCysC (incidence rate ratio, 2.43; 95% CI, 1.31-4.50). By contrast, mGFR and 1/SCr had J-shaped associations with ESRD. In unadjusted analyses, 1/SCysC had the highest area under the receiver operating characteristic curve (AUROC; 0.719 ± 0.035) and mGFR had the lowest (0.585 ± 0.042; P < 0.001); the AUROC for 1/SCr was intermediate (0.672 ± 0.040; P = 0.1 and P = 0.03 vs 1/SCysC and mGFR, respectively). In analyses adjusted for age, sex, diabetes duration, height, weight, hemoglobin A1c level, and ACR, 1/SCysC had the highest AUROC (0.845 ± 0.026). Models with mGFR or 1/SCr alone had similar AUROCs (P = 0.9) and both were lower than the model with 1/SCysC alone (P = 0.02 and P = 0.03, respectively).
The predictive values of the filtration markers are limited to the extent that their precision is based on a single measurement.
SCysC level was a better predictor of ESRD than mGFR or SCr level in Pima Indians with type 2 diabetes and elevated albuminuria.
我们比较了基线血清胱抑素 C（SCysC）、血清肌酐（SCr）和估算肾小球滤过率（mGFR）在预测 2 型糖尿病伴白蛋白尿升高患者终末期肾病（ESRD）中的价值。
观察性纵向研究。
2 型糖尿病伴白蛋白-肌酐比（ACR≥30mg/g）升高的皮马印第安人。
基线 SCysC、SCr 和 mGFR。
个体从首次糖尿病和 ACR≥30mg/g 检查开始随访，直至 2010 年 12 月 ESRD 发作或死亡，以先发生者为准。通过 Mantel-Haenszel 分层计算年龄和性别调整后的发生率。通过受试者工作特征曲线比较 SCysC、SCr 和 mGFR 值预测 ESRD 的能力。
在 234 名平均年龄为 42.8 岁的皮马印第安人中，中位随访时间为 10.7 年（范围，0.6-21.3 年），68 名（29%）发生 ESRD。最低与最高三分之一 1/SCysC 相比，ESRD 的发生率明显更高（发病率比，2.43；95%CI，1.31-4.50）。相比之下，mGFR 和 1/SCr 与 ESRD 呈 J 形关联。在未调整分析中，1/SCysC 的受试者工作特征曲线下面积（AUROC）最高（0.719±0.035），mGFR 最低（0.585±0.042；P<0.001）；1/SCr 的 AUROC 居中（0.672±0.040；P=0.1 和 P=0.03，分别与 1/SCysC 和 mGFR 相比）。在调整年龄、性别、糖尿病病程、身高、体重、糖化血红蛋白水平和 ACR 后，1/SCysC 的 AUROC 最高（0.845±0.026）。仅使用 mGFR 或 1/SCr 的模型具有相似的 AUROCs（P=0.9），均低于仅使用 1/SCysC 的模型（P=0.02 和 P=0.03，分别）。
滤过标志物的预测值仅限于其精度基于单次测量的程度。
在 2 型糖尿病伴白蛋白尿升高的皮马印第安人中，SCysC 水平是预测 ESRD 的更好指标，优于 mGFR 或 SCr 水平。
