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International Journal of Nephrology
Volume 2014, Article ID 127943, 7 pages
http://dx.doi.org/10.1155/2014/127943
Clinical Study

Cystatin C as a Predictor of Mortality and Cardiovascular Events in a Population with Chronic Kidney Disease

1Department of Nephrology, Nephrology Service, Hospital Universitario Severo Ochoa, Avenida. Orellana s/n, Leganés, 28911 Madrid, Spain
2Department of Medical Specialties, Psychology and Applied Pedagogy, Universidad European de Madrid, Villaviciosa de Odon, 28670 Madrid, Spain
3Hypertension Unit, Department of Internal Medicine, Hospital Universitario de Mostoles, Móstoles, 28935 Madrid, Spain
4Department of Biochemistry, Hospital Universitario Severo Ochoa, Leganes, 28911 Madrid, Spain

Received 20 September 2013; Revised 14 December 2013; Accepted 17 December 2013; Published 11 February 2014

Academic Editor: Greg Tesch

Copyright © 2014 Ana Vigil et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. We examine whether cystatin C, a surrogate marker of renal function, could identify patients with chronic kidney disease (CKD) with an increased risk of renal disease progression, death, or cardiovascular events. Methods. Data were obtained for 180 patients, with a diagnosis of chronic renal failure based on serum creatinine estimated glomerular filtration rate (eGFRcreat) <90 mL/min/1.73 m2. This population was grouped in tertiles according to cystatin C and creatinine values at baseline. Cardiovascular events and overall mortality were estimated for each tertile. Predictors of overall mortality and for the development of renal disease progression were analyzed. Results. The median age was 75 years (interquartile range 69–82) and the median eGFRcreat 38 mL/min m2 (interquartile range 33–49). Overall mortality was lower on the first and on the second tertiles of cystatin C than on the third one (HR = 0.060; 95% CI: 0.008–0.447 and HR = 0.094; 95% CI: 0.022–0.406, resp.). Deaths related to the creatinine tertiles followed the same pattern, but differences were not as large. Cardiovascular mortality was lower on the second than on the third cystatin C tertile (HR = 0.198; 95% CI: 0.040–0.987), but it did not show differences on the first and the second creatinine tertiles compared with the third one (HR = 0.126; 95% CI: 0.013–1.265 and HR = 0.403; 95% CI: 0.093–1.740). The only independent predictors of mortality during followup were baseline cystatin C (OR = 0.100; 95% CI: 0.021–0.463) and baseline uric acid (OR = 1.377; 95% CI: 1.070–1.773). Conclusion. Cystatin C may be an alternative to creatinine for detecting a high risk of death and cardiovascular events in a population with CKD.