Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index. Export

@article{citeulike:4640422, abstract = {BACKGOUND: Adiposity is associated with cystatin C. Cystatin C-based glomerular filtration rate (GFR) equations may result in overestimation of chronic kidney disease (CKD) prevalence at greater body mass index (BMI) levels. STUDY DESIGN: Cross-sectional. SETTING \& PARTICIPANTS: 6,709 US adult Third National Health and Nutrition Examination Survey participants. FACTOR: BMI. OUTCOME: Absolute percentage of difference in prevalence of stage 3 or 4 CKD between creatinine- and cystatin C-based estimating equations by level of BMI. MEASUREMENTS: Normal weight, overweight, and obesity were defined as BMI of 18.5 to less than 25.0, 25 to less than 30.0, and 30 kg/m(2) or greater, respectively. Stage 3 or 4 CKD (estimated glomerular filtration rate [eGFR], 15 to 59 mL/min/1.73 m(2)) was defined using the 4-variable creatinine-based Modification of Diet in Renal Disease Study equation (eGFR(MDRD)); cystatin C level, age, sex, and race equation (eGFR(CysC,age,sex,race)); cystatin C-only equation (eGFR(CysC)); cystatin C level of 1.12 mg/L or greater (increased cystatin C); and an equation incorporating serum creatinine level, cystatin C level, age, sex, and race (eGFR(Cr,CysC,age,sex,race)). RESULTS: Differences in stage 3 or 4 CKD prevalence estimates between eGFR(CysC,age,sex,race), eGFR(CysC), and increased cystatin C, separately, and eGFR(MDRD) were greater at higher BMI levels. Specifically, compared with estimates derived using eGFR(MDRD) for normal-weight, overweight, and obese participants, estimated prevalences of stage 3 or 4 CKD were 2.1\%, 3.0\%, and 6.5\% greater when estimated by using eGFR(CysC,age,sex,race) (P trend = 0.005); 0.1\%, 0.6\%, and 2.2\% greater for eGFR(CysC) (P trend = 0.03); 2.9\%, 5.2\%, and 9.5\% greater for increased cystatin C (P trend < 0.001); and -0.1\%, -0.4\%, and 0.0\% greater for eGFR(Cr,CysC,age,sex,race), respectively (P trend = 0.7). LIMITATIONS: No gold-standard measure of GFR was available. CONCLUSIONS: BMI may influence the estimated prevalence of stage 3 or 4 CKD when cystatin C-based equations are used.}, author = {Vupputuri, Suma and Fox, Caroline S. and Coresh, Josef and Woodward, Mark and Muntner, Paul}, citeulike-article-id = {4640422}, citeulike-linkout-0 = {http://dx.doi.org/10.1053/j.ajkd.2008.12.043}, citeulike-linkout-1 = {http://linkinghub.elsevier.com/retrieve/pii/S0272638609004260}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/19394726}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=19394726}, doi = {10.1053/j.ajkd.2008.12.043}, issn = {1523-6838}, journal = {American journal of kidney diseases : the official journal of the National Kidney Foundation}, keywords = {bmi, creatinine, cystatin, gfr-formula}, month = {June}, number = {6}, pages = {993--1001}, posted-at = {2009-05-27 04:37:23}, priority = {2}, title = {Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index.}, url = {http://dx.doi.org/10.1053/j.ajkd.2008.12.043}, volume = {53}, year = {2009} }

TY - JOUR ID - citeulike:4640422 L3 - citeulike-article-id:4640422 N2 - BACKGOUND: Adiposity is associated with cystatin C. Cystatin C-based glomerular filtration rate (GFR) equations may result in overestimation of chronic kidney disease (CKD) prevalence at greater body mass index (BMI) levels. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 6,709 US adult Third National Health and Nutrition Examination Survey participants. FACTOR: BMI. OUTCOME: Absolute percentage of difference in prevalence of stage 3 or 4 CKD between creatinine- and cystatin C-based estimating equations by level of BMI. MEASUREMENTS: Normal weight, overweight, and obesity were defined as BMI of 18.5 to less than 25.0, 25 to less than 30.0, and 30 kg/m(2) or greater, respectively. Stage 3 or 4 CKD (estimated glomerular filtration rate [eGFR], 15 to 59 mL/min/1.73 m(2)) was defined using the 4-variable creatinine-based Modification of Diet in Renal Disease Study equation (eGFR(MDRD)); cystatin C level, age, sex, and race equation (eGFR(CysC,age,sex,race)); cystatin C-only equation (eGFR(CysC)); cystatin C level of 1.12 mg/L or greater (increased cystatin C); and an equation incorporating serum creatinine level, cystatin C level, age, sex, and race (eGFR(Cr,CysC,age,sex,race)). RESULTS: Differences in stage 3 or 4 CKD prevalence estimates between eGFR(CysC,age,sex,race), eGFR(CysC), and increased cystatin C, separately, and eGFR(MDRD) were greater at higher BMI levels. Specifically, compared with estimates derived using eGFR(MDRD) for normal-weight, overweight, and obese participants, estimated prevalences of stage 3 or 4 CKD were 2.1%, 3.0%, and 6.5% greater when estimated by using eGFR(CysC,age,sex,race) (P trend = 0.005); 0.1%, 0.6%, and 2.2% greater for eGFR(CysC) (P trend = 0.03); 2.9%, 5.2%, and 9.5% greater for increased cystatin C (P trend < 0.001); and -0.1%, -0.4%, and 0.0% greater for eGFR(Cr,CysC,age,sex,race), respectively (P trend = 0.7). LIMITATIONS: No gold-standard measure of GFR was available. CONCLUSIONS: BMI may influence the estimated prevalence of stage 3 or 4 CKD when cystatin C-based equations are used. IS - 6 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation SN - 1523-6838 EP - 1001 TI - Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index. VL - 53 SP - 993 KW - bmi KW - creatinine KW - cystatin KW - gfr-formula AU - Vupputuri, Suma AU - Fox, Caroline AU - Coresh, Josef AU - Woodward, Mark AU - Muntner, Paul PY - 2009/06// UR - http://dx.doi.org/10.1053/j.ajkd.2008.12.043 ER -