Association of cystatin C with adverse outcomes.
OBJECTIVE
To discuss recent studies which have evaluated determinants of cystatin C and to focus on the relationship of cystatin C with mortality, cardiovascular disease (CVD), and noncardiovascular outcomes.


RESULTS
In the Chronic Kidney Disease Epidemiology Study cystatin C was associated with demographic characteristics independent of measured glomerular filtration rate (GFR), although this was to a smaller extent than creatinine. In patients with established chronic kidney disease (CKD), cystatin C was strongly and inversely correlated with measured GFR, suggesting that although cystatin C may have other determinants, it is primarily a measure of kidney function. Several cohort studies, particularly in older adults, have now demonstrated that cystatin C is linearly associated with mortality, CVD and non-CVD outcomes, whereas creatinine is primarily associated with risk in individuals with more advanced kidney disease. A recent study has also shown that changes in kidney function as ascertained by cystatin C, even within the relatively normal range, are associated with subsequent CVD and all-cause mortality among older adults.


CONCLUSIONS
Cystatin C appears to capture an association of mild kidney disease with increased risk of mortality, CVD and non-CVD outcomes. Future studies should evaluate whether cystatin C can improve medical decision-making and lead to favorable patient outcomes.
Madero
Magdalena
M
Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico.
Sarnak
Mark J
MJ
D000818:Animals; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D055316:Cystatin C / Q000378:metabolism / Q000502:physiology*; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D012307:Risk Factors
D055316:Cystatin C