Creatinine-versus cystatin C-based renal function assessment in the Northern Manhattan Study

Abstract

Background: Accurate glomerular filtration rate estimation informs drug dosing and risk stratification. Body composition heterogeneity influences creatinine production and the precision of creatinine-based estimated glomerular filtration rate (eGFR cr ) in the elderly. We compared chronic kidney disease (CKD) categorization using eGFR cr and cystatin C-based estimated GFR (eGFR cys ) in an elderly, racially/ethnically diverse cohort to determine their concordance. Methods: The Northern Manhattan Study (NOMAS) is a predominantly elderly, multi-ethnic cohort with a primary aim to study cardiovascular disease epidemiology. We included participants with concurrently measured creatinine and cystatin C. eGFR cr was calculated using the CKD-EPI2009 equation. eGFR cys was calculated using the CKD-EPI 2012 equation. Logistic regression was used to estimate odds ratios and 95% confidence intervals of factors associated with reclassification from eGFR cr ≥60ml/min/1.73m 2 to eGFR cys <60ml/min/1.73m 2 . Results: Participants (n = 2988, mean age 69±10yrs) were predominantly Hispanic, female, and overweight/obese. eGFR cys was lower than eGFR cr by mean 23mL/min/1.73m 2 .51% of participants' CKD status was discordant, and only 28% maintained the same CKD stage by both measures. Most participants (78%) had eGFR cr ≥60mL/min/1.73m 2 ; among these, 64% had eGFR cys <60mL/min/1.73m 2 . Among participants with eGFR cr ≥60mL/min/1.73m 2 , eGFR cys -based reclassification was more likely in those with age >65 years, obesity, current smoking, white race, and female sex. Conclusions: In a large, multiethnic, elderly cohort, we found a highly discrepant prevalence of CKD with eGFR cys versus eGFR cr . Determining the optimal method to estimate GFR in elderly populations needs urgent further study to improve risk stratification and drug dosing.