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The cystatin C/creatinine ratio, a marker of glomerular filtration quality: associated factors, reference intervals, and prediction of morbidity and mortality in healthy seniors.

  • Purde MT Labormedizinisches Zentrum Dr. Risch, Schaan, Liechtenstein; Tallinn University of Technology, Faculty of Science, Tallinn, Estonia.
  • Nock S Private University, Triesen, Liechtenstein.
  • Risch L Labormedizinisches Zentrum Dr. Risch, Schaan, Liechtenstein; Division of Clinical Biochemistry, Medical University Innsbruck, Innsbruck, Austria.
  • Medina Escobar P Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland.
  • Grebhardt C Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland.
  • Nydegger UE Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland.
  • Stanga Z Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Risch M Kantonsspital Graubünden, Zentrallabor, Chur, Switzerland. Electronic address: martin.risch@ksgr.ch.
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  • 2015-12-07
Published in:
  • Translational research : the journal of laboratory and clinical medicine. - 2016
Aged
Aged, 80 and over
Biomarkers
Creatinine
Cystatin C
Female
Glomerular Filtration Rate
Humans
Male
Morbidity
Mortality
Reference Values
English The ratio of cystatin C (cysC) to creatinine (crea) is regarded as a marker of glomerular filtration quality associated with cardiovascular morbidities. We sought to determine reference intervals for serum cysC-crea ratio in seniors. Furthermore, we sought to determine whether other low-molecular weight molecules exhibit a similar behavior in individuals with altered glomerular filtration quality. Finally, we investigated associations with adverse outcomes. A total of 1382 subjectively healthy Swiss volunteers aged 60 years or older were enrolled in the study. Reference intervals were calculated according to Clinical & Laboratory Standards Institute (CLSI) guideline EP28-A3c. After a baseline exam, a 4-year follow-up survey recorded information about overall morbidity and mortality. The cysC-crea ratio (mean 0.0124 ± 0.0026 mg/μmol) was significantly higher in women and increased progressively with age. Other associated factors were hemoglobin A1c, mean arterial pressure, and C-reactive protein (P < 0.05 for all). Participants exhibiting shrunken pore syndrome had significantly higher ratios of 3.5-66.5 kDa molecules (brain natriuretic peptide, parathyroid hormone, β2-microglobulin, cystatin C, retinol-binding protein, thyroid-stimulating hormone, α1-acid glycoprotein, lipase, amylase, prealbumin, and albumin) and creatinine. There was no such difference in the ratios of very low-molecular weight molecules (urea, uric acid) to creatinine or in the ratios of molecules larger than 66.5 kDa (transferrin, haptoglobin) to creatinine. The cysC-crea ratio was significantly predictive of mortality and subjective overall morbidity at follow-up in logistic regression models adjusting for several factors. The cysC-crea ratio exhibits age- and sex-specific reference intervals in seniors. In conclusion, the cysC-crea ratio may indicate the relative retention of biologically active low-molecular weight compounds and can independently predict the risk for overall mortality and morbidity in the elderly.
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  • English
Open access status
hybrid
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https://sonar.ch/global/documents/278666
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