Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease.
BACKGROUND
Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD).


RESULTS
We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF)>40%. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e' velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p=0.0055), LVEF (p=0.0432), LVMI (p=0.0409), e' (p=0.0051), E/e' (p=0.0027), and log-transformed NT-proBNP (p<0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38%; Q2 49%; Q3, 51%; Q4, 66%, p=0.0008), mainly because of increasing concentric hypertrophy (Q1, 30%; Q2, 39%; Q3, 39%; Q4, 51%, p=0.0187).


CONCLUSIONS
A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan. Electronic address: s-sakura@sc4.so-net.ne.jp.
Satoru
S
Sakuragi
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Keishi
K
Ichikawa
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Keiji
K
Yamada
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Masafumi
M
Tanimoto
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Takashi
T
Miki
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Hiroaki
H
Otsuka
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Kazuhiko
K
Yamamoto
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Kenji
K
Kawamoto
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Yusuke
Y
Katayama
Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
Machiko
M
Tanakaya
Department of Cardiovascular Medicine, Okayama University Graduate School of Medical and Dentistry, Okayama, Japan.
Hiroshi
H
Ito
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D055815:Young Adult
D015415:Biomarkers; D055316:Cystatin C
Cystatin C; LV relaxation; Left atrial enlargement; Left ventricular hypertrophy