Fang Wei-Ching, Chen Hsing-Yu, Chu Shao-Chi, Wang Po-Hsi, Lee Chin-Chan, Wu I-Wen, Sun Chiao-Yin, Hsu Heng-Jung, Chen Chun-Yu, Chen Yung-Chang, Wu Vin-Cent, Pan Heng-Chih
Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Biomedicines. 2022 Nov 2;10(11):2789. doi: 10.3390/biomedicines10112789.
Several biomarkers have been correlated with the prevalence and severity of chronic kidney disease (CKD); however, the association between biomarkers and rapid kidney function decline (RKFD) is unknown. This study aimed to evaluate the predictive performance of biomarkers to determine who is likely to develop RKFD in a healthy population.
A community-based cohort of 2608 people residing in northern Taiwan were enrolled, and their renal function was followed annually from January 2014 to December 2019. The outcomes of interest were RKFD, defined as a 15% decrease in the estimated glomerular filtration rate (eGFR) within the first 4 years, and a decrease in eGFR without improvement in the fifth year. Clinical variables and potential predictors of RKFD, namely adiponectin, leptin, tumor necrosis factor-alpha, and cystatin C, were measured and analyzed.
The incidence of RKFD was 17.0% (105/619). After matching for age and sex at a 1:1 ratio, a total of 200 subjects were included for analysis. The levels of cystatin C and total vitamin D were significantly negatively correlated with eGFR. eGFR was negatively correlated with the levels of cystatin C and total vitamin D. Among the biomarkers, cystatin C showed the best predictive performance for RKFD (area under the receiver operating characteristic curve: 0.789). Lower serum cystatin C was associated with a higher rate of RKFD in healthy subjects. A generalized additive model showed that 0.82 mg/L was an adequate cut-off value of cystatin C to predict RKFD. Multivariable logistic regression analysis further indicated that low cystatin C and eGFR were independent predictors of the possibility of RKFD.
Serum cystatin C level could predict the possibility of RKFD. We suggest that a low cystatin C level should be considered as a risk factor for RKFD in healthy subjects.
多种生物标志物已被证实与慢性肾脏病（CKD）的患病率和严重程度相关；然而，生物标志物与肾功能快速下降（RKFD）之间的关联尚不清楚。本研究旨在评估生物标志物的预测性能，以确定健康人群中哪些人可能发生RKFD。
纳入了居住在台湾北部的2608人的社区队列，从2014年1月至2019年12月每年对他们的肾功能进行随访。感兴趣的结局是RKFD，定义为在最初4年内估计肾小球滤过率（eGFR）下降15%，以及在第5年eGFR下降且无改善。测量并分析了临床变量以及RKFD的潜在预测指标，即脂联素、瘦素、肿瘤坏死因子-α和胱抑素C。
RKFD的发生率为17.0%（105/619）。按1:1的年龄和性别匹配后，共纳入200名受试者进行分析。胱抑素C水平和总维生素D水平与eGFR显著负相关。eGFR与胱抑素C水平和总维生素D水平呈负相关。在这些生物标志物中，胱抑素C对RKFD的预测性能最佳（受试者工作特征曲线下面积：0.789）。健康受试者中较低的血清胱抑素C与较高的RKFD发生率相关。广义相加模型显示，0.82mg/L是预测RKFD的胱抑素C合适截断值。多变量逻辑回归分析进一步表明，低胱抑素C和eGFR是RKFD可能性的独立预测因素。
血清胱抑素C水平可预测RKFD的可能性。我们建议，在健康受试者中，低胱抑素C水平应被视为RKFD的一个危险因素。
