Vigil Ana, Condés Emilia, Vigil Luis, Gallar Paloma, Oliet Aniana, Ortega Olimpia, Rodriguez Isabel, Ortiz Milagros, Herrero Juan Carlos, Mon Carmen, Cobo Gabriela, Jimenez Juana
Department of Nephrology, Nephrology Service, Hospital Universitario Severo Ochoa, Avenida. Orellana s/n, Leganés, 28911 Madrid, Spain.
Department of Medical Specialties, Psychology and Applied Pedagogy, Universidad European de Madrid, Villaviciosa de Odon, 28670 Madrid, Spain.
Int J Nephrol. 2014;2014:127943. doi: 10.1155/2014/127943. Epub 2014 Feb 11.
Background. We examine whether cystatin C, a surrogate marker of renal function, could identify patients with chronic kidney disease (CKD) with an increased risk of renal disease progression, death, or cardiovascular events. Methods. Data were obtained for 180 patients, with a diagnosis of chronic renal failure based on serum creatinine estimated glomerular filtration rate (eGFRcreat) <90 mL/min/1.73 m(2). This population was grouped in tertiles according to cystatin C and creatinine values at baseline. Cardiovascular events and overall mortality were estimated for each tertile. Predictors of overall mortality and for the development of renal disease progression were analyzed. Results. The median age was 75 years (interquartile range 69-82) and the median eGFRcreat 38 mL/min m(2) (interquartile range 33-49). Overall mortality was lower on the first and on the second tertiles of cystatin C than on the third one (HR = 0.060; 95% CI: 0.008-0.447 and HR = 0.094; 95% CI: 0.022-0.406, resp.). Deaths related to the creatinine tertiles followed the same pattern, but differences were not as large. Cardiovascular mortality was lower on the second than on the third cystatin C tertile (HR = 0.198; 95% CI: 0.040-0.987), but it did not show differences on the first and the second creatinine tertiles compared with the third one (HR = 0.126; 95% CI: 0.013-1.265 and HR = 0.403; 95% CI: 0.093-1.740). The only independent predictors of mortality during followup were baseline cystatin C (OR = 0.100; 95% CI: 0.021-0.463) and baseline uric acid (OR = 1.377; 95% CI: 1.070-1.773). Conclusion. Cystatin C may be an alternative to creatinine for detecting a high risk of death and cardiovascular events in a population with CKD.
背景。我们研究了肾功能替代标志物胱抑素C是否能够识别出慢性肾脏病（CKD）患者中肾病进展、死亡或心血管事件风险增加的患者。方法。获取了180例基于血清肌酐估算肾小球滤过率（eGFRcreat）<90 mL/min/1.73 m²诊断为慢性肾衰竭的患者的数据。该人群根据基线时的胱抑素C和肌酐值分为三个三分位数组。对每个三分位数组估计心血管事件和总死亡率。分析总死亡率和肾病进展发生情况的预测因素。结果。中位年龄为75岁（四分位间距69 - 82），中位eGFRcreat为38 mL/min/m²（四分位间距33 - 49）。胱抑素C的第一个和第二个三分位数组的总死亡率低于第三个三分位数组（风险比[HR]=0.060；95%置信区间[CI]：0.008 - 0.447和HR = 0.094；95% CI：0.022 - 0.406）。与肌酐三分位数组相关的死亡情况遵循相同模式，但差异没有那么大。胱抑素C的第二个三分位数组的心血管死亡率低于第三个三分位数组（HR = 0.198；95% CI：0.040 - 0.987），但与第三个三分位数组相比，肌酐的第一个和第二个三分位数组未显示出差异（HR = 0.126；95% CI：0.013 - 1.265和HR =
0.403；95% CI：0.093 - 1.740）。随访期间死亡率的唯一独立预测因素是基线胱抑素C（比值比[OR]=0.100；95% CI：0.021 - 0.463）和基线尿酸（OR = 1.377；95% CI：1.070 - 1.773）。结论。在CKD人群中，胱抑素C可能是一种替代肌酐用于检测高死亡风险和心血管事件风险的指标。
