title: Serum cystatin C as a predictor for cardiovascular events in end-stage renal disease patients at the initiation of dialysis.
abstract: BACKGROUND
  There has been no study to investigate whether cystatin C could predict cardiovascular events in incident dialysis patients. We aimed to delineate the role of serum cystatin C and cystatin C-based estimated glomerular filtration rate (eGFR(cysC)) for prediction of cardiovascular events.
  
  
  METHODS
  This study included 66 end-stage renal disease patients who survived for >3 months after the start of dialysis, and serum cystain C levels were measured at the point of dialysis initiation.
  
  
  RESULTS
  Serum cystatin C was correlated with blood urea nitrogen (r = 0.537, p < 0.001), serum creatinine (r = 0.480, p < 0.001) and smoking (r = 0.284, p = 0.021). Cystatin C was inversely correlated with age (r = -0.316, p = 0.01) and eGFR(Cr) by modification of diet in renal disease (r = -0.533, p < 0.001). Kaplan-Meier analysis for cardiovascular events revealed that patients in the group with lower cystatin C levels (<4.14 mg/L) had a better event-free survival rate than patients in the group with higher cystatin C levels (≥4.14 mg/L) (p = 0.039). In univariate analysis, cystatin C (hazard ratio (HR) 2.62, p = 0.011) and eGFR(cysC) (HR 0.64, p = 0.004) were significant factors for the prediction of cardiovascular events. After multivariate adjustment, serum cystatin C and eGFR(cysC) were independent determinants of cardiovascular events (HR 3.952, p = 0.001 and HR 0.640, p = 0.004, respectively).
  
  
  CONCLUSIONS
  Serum cystatin C might be an independent marker of cardiovascular events in incident dialysis patients. Furthermore, eGFR(cysC) based on measured serum cystatin C could have a new role in predicting cardiovascular events beyond the estimation of true GFR.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital School of Medicine, Busan, Republic of Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Shin
authors.forename: Sang Heon
authors.initials: SH
authors.lastname: Song
authors.forename: Ihm Soo
authors.initials: IS
authors.lastname: Kwak
authors.forename: Soo Bong
authors.initials: SB
authors.lastname: Lee
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Lee
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Seong
authors.forename: Il Young
authors.initials: IY
authors.lastname: Kim
authors.forename: Harin
authors.initials: H
authors.lastname: Rhee
authors.forename: Naria
authors.initials: N
authors.lastname: Lee
mesh_terms: D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D002318:Cardiovascular Diseases / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012306:Risk
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine