Xin Guangda, Li Qianyu, Sheng Chen, Zha Yining, Cheng Kailiang
Department of Radiology, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China.
Harvard T H Chan School of Public Health, Boston, USA.
Nutr Metab (Lond). 2024 Nov 19;21(1):94. doi: 10.1186/s12986-024-00870-4.
Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 and European Kidney Function Consortium (EKFC) 2023 both recently updated the equations to estimate the glomerular filtration rate (eGFR) using cystatin C; however, little is known about the benefits of using the equations for the risk stratification of health outcomes. We conducted this longitudinal study to compare the cystatin C CKD-EPI and EKFC equations to track the risks of cardiovascular disease and all-cause mortality among Chinese adults.
We used data from China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Adjusted logistic regression models and restricted cubic spline functions were used to evaluate the relationships of cystatin C-based eGFR values with incidence of cardiovascular disease and mortality.
A total of 6 496 participants were finally included in this study. The mean age of the participants was 59.6 (± 9.5) years, including 2996 (46.1%) males. There were 473 deaths and 1996 cases of cardiovascular disease observed during a maximum follow-up of 7.0 years. Using cystatin C-based CKD-EPI equation, people of eGFR < 60 mL/min/1.73 m had an increased risk of mortality (risk ratio [RR], 1.527; 95% CI, 1.068-2.178) and incident cardiovascular disease (RR, 1.363; 95% CI, 1.006-1.844), compared to those of eGFR ≥ 90 mL/min/1.73 m. On the contrary, we did not observe significant associations of eGFR levels by EKFC equation with mortality nor cardiovascular disease.
The findings indicated that cystatin C-based eGFR using CKD-EPI equation is more closely associated with all-cause mortality and cardiovascular disease compared to EKFC equation among Chinese adults. The cystatin C-based eGFR by CKD-EPI equation should be monitored in health practice, which needs further validation in other populations.
慢性肾脏病流行病学协作组（CKD-EPI）2021年方程和欧洲肾功能联盟（EKFC）2023年方程最近均更新了使用胱抑素C估算肾小球滤过率（eGFR）的方程；然而，对于使用这些方程进行健康结局风险分层的益处知之甚少。我们开展了这项纵向研究，以比较胱抑素C的CKD-EPI方程和EKFC方程，来追踪中国成年人中心血管疾病风险和全因死亡率。
我们使用了中国健康与养老追踪调查（CHARLS）2011年至2018年的数据。采用校正后的逻辑回归模型和受限立方样条函数来评估基于胱抑素C的eGFR值与心血管疾病发病率和死亡率之间的关系。
本研究最终纳入了6496名参与者。参与者的平均年龄为59.6（±9.5）岁，其中男性2996名（46.1%）。在最长7.0年的随访期间，观察到473例死亡和1996例心血管疾病病例。与eGFR≥90 mL/min/1.73 m的人群相比，使用基于胱抑素C的CKD-EPI方程时，eGFR<60 mL/min/1.73 m的人群死亡率风险增加（风险比[RR]，1.527；95%置信区间[CI]，1.068-2.178），心血管疾病发病风险增加（RR，1.363；95%CI，1.006-1.844）。相反，我们未观察到基于EKFC方程的eGFR水平与死亡率或心血管疾病之间存在显著关联。
研究结果表明，在中国成年人中，与EKFC方程相比，基于胱抑素C使用CKD-EPI方程的eGFR与全因死亡率和心血管疾病的关联更为密切。在健康实践中应监测基于CKD-EPI方程的胱抑素C的eGFR，这需要在其他人群中进一步验证。
