title: Cystatin C and albuminuria as risk factors for development of CKD stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  The growing burden and morbidity of chronic kidney disease (CKD) warrant effective strategies for identifying those at increased risk. We examined the association of cystatin C level and albuminuria with the development of CKD stage 3.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  5,422 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2).
  
  
  METHODS
  Participants were categorized into 4 mutually exclusive groups: the presence or absence of microalbuminuria (albumin-creatinine ratio >17 and >25 μg/mg in men and women, respectively) in those with or without cystatin C level ≥1.0 mg/L.
  
  
  METHODS
  Incident CKD stage 3 was defined as eGFR <60 mL/min/1.73 m(2) at the third or fourth visit and an annual decrease >1 mL/min/1.73 m(2). Poisson regression was used to evaluate incident rate ratios in unadjusted and adjusted analyses that include baseline eGFR.
  
  
  RESULTS
  Mean age was 61 years, 49% were men, 38% were white, 11% had diabetes, 13.7% had cystatin C level ≥1 mg/L, 8.4% had microalbuminuria, and 2.7% had cystatin C level ≥1 mg/L with microalbuminuria. 554 (10%) participants developed CKD stage 3 during a median follow-up of 4.7 years, and adjusted incidence rate ratios were 1.57 (95% CI, 1.19-2.07), 1.37 (95% CI, 1.13-1.66), and 2.12 (95% CI, 1.61-2.80) in those with microalbuminuria, cystatin C level ≥1 mg/L, and both, respectively, compared with those with neither.
  
  
  CONCLUSIONS
  Relatively short follow-up and absence of measured GFR.
  
  
  CONCLUSIONS
  Cystatin C level and microalbuminuria are independent risk factors for incident CKD stage 3 and could be useful as screening tools to identify those at increased risk.
authors.affiliation: Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA.
authors.forename: Shani
authors.initials: S
authors.lastname: Shastri
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000097:blood / Q000150:complications* / Q000208:ethnology; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000208:ethnology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C