title: Cystatin C estimated glomerular filtration rate and all-cause and cardiovascular disease mortality risk in the general population: AusDiab study.
abstract: OBJECTIVE
  Uncertainties about the role of cystatin C-based estimated glomerular filtration rate (eGFR) in the prediction of cardiovascular disease (CVD) beyond traditional CVD risk factors remain. We assessed contributions of eGFR to CVD and mortality in the general population.
  
  
  METHODS
  Using 14 year follow-up data on 9353 adults without a reported history of CVD from the Australian Diabetes, Obesity and Lifestyle study, we assessed the contributions of eGFR (assessed by cystatin C (eGFRcysC) and serum creatinine (eGFRcr) and albuminuria (uACR) to total and CVD mortality.
  
  
  RESULTS
  After adjusting for age, sex, CVD risk factors and uACR, compared with an eGFRcysC>90 mL/min per 1.73 m2, eGFRcysC<60 mL/min per 1.73 m2was associated with 56% and 73% increases in the risks for all-cause and CVD mortality, respectively. The respective changes for the c-statistic when eGFRcysCwas added to a risk prediction model were 0.003 (95% confidence interval: 0.001 to 0.005) and 0.002 (95% confidence interval: -0.001 to 0.006). The net proportion of non-events assigned a lower-risk category significantly improved with the addition of eGFR (non-event net reclassification index eGFRcr: 1.0% and eGFRcysC: 1.5%) for all-cause mortality, but for CVD mortality, improvements were only significant when eGFR was combined with uACR. The net proportion of events assigned a higher-risk category was not significantly improved.
  
  
  CONCLUSIONS
  In our community-based cohort, reduced eGFRcysCwas associated with all-cause and CVD mortality. The addition of chronic kidney disease measures to risk prediction models improved overall risk stratification among those at low risk as opposed to those at high baseline risk of mortality.
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Menzies School of Health Research, Darwin, Northern Territory, Australia.
authors.forename: Elizabeth Lm
authors.initials: EL
authors.lastname: Barr
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Reutens
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: Melbourne Pathology, Melbourne, Victoria, Australia.
authors.forename: Zhong X
authors.initials: ZX
authors.lastname: Lu
authors.affiliation: Melbourne Pathology, Melbourne, Victoria, Australia.
authors.forename: Ken A
authors.initials: KA
authors.lastname: Sikaris
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Tanamas
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Atkins
authors.affiliation: Sydney University, Sydney, New South Wales, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Chadban
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D015331:Cohort Studies; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C
keywords: cardiovascular diseases; cystatin C; estimated glomerular filtration rate; mortality; risk factors