Urinary cystatin C as a potential risk marker for cardiovascular disease and chronic kidney disease in patients with obesity and metabolic syndrome.
OBJECTIVE
Obesity and metabolic syndrome (MS) increase the risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and all-cause mortality. Serum cystatin C (S-CysC), a marker of GFR, has been shown to be associated with CVD and CKD. This study was designed to elucidate the association of urinary CysC (U-CysC), a marker of renal tubular dysfunction, with CVD and CKD risk factors in patients with obesity and MS.


METHODS
The U-CysC-creatinine ratio (UCCR) was examined in 343 Japanese obese outpatients enrolled in the multi-centered Japan Obesity and Metabolic Syndrome Study.


RESULTS
UCCR was positively correlated with urine albumin-creatinine ratio (UACR) and S-CysC and negatively correlated with estimated GFR (eGFR). Among obese patients, UCCR was significantly higher in MS patients than in non-MS patients. UCCR had significant correlations with the number of components of MS and arterial stiffness, all of which are CVD predictors, similarly to UACR (P<0.05). Interestingly, diet- and exercise-induced weight reduction for 3 months significantly decreased only UCCR among all of the renal markers examined (P<0.01), in parallel with the decrease in BMI, HbA1c, and arterial stiffness, suggesting the beneficial effect of weight reduction on renal tubular dysfunction.


CONCLUSIONS
This study demonstrates that UCCR is significantly associated with renal dysfunction, the severity of MS, arterial stiffness, and weight change in obese patients. The data of this study suggest that U-CysC could serve as a CVD and CKD risk factor in patients with obesity and MS.
Division of Diabetic Research, Clinical Research Institute, Diabetes Center, Department of Nephrology, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan. norikos@oregano.ocn.ne.jp
Noriko
N
Satoh-Asahara
Takayoshi
T
Suganami
Takafumi
T
Majima
Kazuhiko
K
Kotani
Yasuhisa
Y
Kato
Rika
R
Araki
Kazunori
K
Koyama
Taiichiro
T
Okajima
Makito
M
Tanabe
Mariko
M
Oishi
Akihiro
A
Himeno
Shigeo
S
Kono
Akira
A
Sugawara
Masakazu
M
Hattori
Yoshihiro
Y
Ogawa
Akira
A
Shimatsu
D000419:Albuminuria / Q000209:etiology / Q000652:urine; D000704:Analysis of Variance; D001158:Arteries / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000652:urine*; D018450:Disease Progression; D004548:Elasticity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology / Q000628:therapy / Q000652:urine; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D015431:Weight Loss
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine