title: Comparison of cystatin C- and creatinine-based estimated glomerular filtration rates for predicting all-cause mortality in Japanese patients with type 2 diabetes: the Fukuoka Diabetes Registry.
abstract: BACKGROUND
  There is little information about the predictive ability of cystatin C-based estimated glomerular filtration rates (eGFRCys) for all-cause mortality in Asian populations. We compared the discriminatory ability of eGFRCysfor all-cause mortality with that of creatinine-based estimated glomerular filtration rates (eGFRCr) in Japanese patients with type 2 diabetes.
  
  
  METHODS
  A total of 4869 participants were classified into four categories (eGFR ≤29, 30-59, 60-89, and ≥90 ml/min/1.73 m2) by eGFRCrand eGFRCys, and followed up for a median of 3.3 years.
  
  
  RESULTS
  150 deaths were identified. The multivariable-adjusted risk of all-cause mortality was significantly increased in eGFRCr≤29 ml/min/1.73 m2compared with eGFRCr≥90 ml/min/1.73 m2[hazard ratio (HR) 2.4 (95 % confidence interval (95 % CI) 1.2-5.0)], whereas it was significantly increased in eGFRCys59 ml/min/1.73 m2or lower [30-59 ml/min/1.73 m2, HR 1.9 (95 % CI 1.1-3.5); ≤29 ml/min/1.73 m2, HR 5.8 (95 % CI 2.8-12.0)]. Comparing eGFRCyswith eGFRCr, the proportions of participants reclassified to lower and higher eGFR stages were 6.3 and 28.8 %, respectively. The multivariable-adjusted HRs for all-cause mortality were 1.8 (95 % CI 1.1-2.9) and 0.7 (95 % CI 0.4-1.1), respectively. The C statistic of the model including eGFRCysand other risk factors was significantly increased compared with the model including eGFRCr. The net reclassification improvement and the integrated discrimination improvement were significantly positive.
  
  
  CONCLUSIONS
  Our findings suggest that eGFRCyshas a stronger association with all-cause mortality and is superior to eGFRCrfor predicting all-cause mortality in Japanese patients with type 2 diabetes.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. iwase@med.kyushu-u.ac.jp.|Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan. iwase@med.kyushu-u.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Iwase
authors.affiliation: Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental University, Kitakyushu, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ohkuma
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Shinako
authors.initials: S
authors.lastname: Kaizu
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Jodai
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Idewaki
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Sumi
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Udai
authors.initials: U
authors.lastname: Nakamura
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
mesh_terms: D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine
keywords: Chronic kidney disease; Cystatin C; Risk reclassification; Type 2 diabetes