title: Combined association of albuminuria and cystatin C-based estimated GFR with mortality, coronary heart disease, and heart failure outcomes: the Atherosclerosis Risk in Communities (ARIC) Study.
abstract: BACKGROUND
  Serum cystatin C level has been shown to have a stronger association with clinical outcomes than serum creatinine level. However, little is known about the combined association of cystatin C-based estimated glomerular filtration rate (eGFR(cys)) and albuminuria with clinical outcomes, particularly at levels lower than current chronic kidney disease (CKD) cutoffs.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  10,403 ARIC (Atherosclerosis Risk in Communities) Study participants followed up for a median of 10.2 years.
  
  
  METHODS
  eGFR(cys), albuminuria.
  
  
  RESULTS
  Mortality, coronary heart disease (CHD), and heart failure, as well as a composite of any of these separate outcomes.
  
  
  RESULTS
  Both decreased eGFR(cys) and albuminuria were associated independently with the composite outcome, as well as mortality, CHD, and heart failure. Although eGFR(cys) of 75-89 mL/min/1.73 m(2) in the absence of albuminuria (albumin-creatinine ratio [ACR] <10 mg/g) or albuminuria with ACR of 10-29 mg/g with normal eGFR(cys) (90-104 mL/min/1.73 m(2)) was not associated significantly with any outcome compared with eGFR(cys) of 90-104 mL/min/1.73 m(2) and ACR <10 mg/g, the risk of each outcome was significantly higher in those with both eGFR(cys) of 75-89 mL/min/1.73 m(2) and ACR of 10-29 mg/g (for mortality, HR of 1.4 [95% CI, 1.1-2.0]; for CHD, HR of 1.9 [95% CI, 1.4-2.6]; for heart failure, HR of 1.8 [95% CI, 1.2-2.7]). Combining the 2 markers improved risk classification for all outcomes (P < 0.001), even in those without overt CKD.
  
  
  CONCLUSIONS
  Only one measurement of cystatin C.
  
  
  CONCLUSIONS
  Mildly decreased eGFR(cys) and mild albuminuria independently contributed to the risk of mortality, CHD, and heart failure. Even minimally decreased eGFR(cys) (75-89 mL/min/1.73 m(2)) is associated with increased risk in the presence of mild albuminuria. Combining the 2 markers is useful for improved risk stratification even in those without clinical CKD.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. swaheed1@jhmi.edu
authors.forename: Salman
authors.initials: S
authors.lastname: Waheed
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.forename: Ron
authors.initials: R
authors.lastname: Hoogeveen
authors.forename: Christie
authors.initials: C
authors.lastname: Ballantyne
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
mesh_terms: D000419:Albuminuria / Q000453:epidemiology*; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D055316:Cystatin C