title: Biomarkers of kidney function and prediction of death from cardiovascular and other causes in the elderly: A 9-year follow-up study.
abstract: BACKGROUND
  Cystatin C is claimed to be superior to creatinine-based estimates of glomerular filtration rate (eGFRcr). The purpose of the study is to analyze whether cystatin C, creatinine, and/or estimated glomerular filtration rates (eGFR) predicted cardiovascular and/or non-cardiovascular deaths among Finnish elderly.
  
  
  METHODS
  Hazard ratios (HR) of cystatin C, creatinine and eGFRs for cardiovascular and non-cardiovascular deaths.
  
  
  RESULTS
  During a 9-year follow-up, 275 died, 192 deaths were a result of cardiovascular disease. In age-adjusted analyses, cystatin C predicted the risk of non-cardiovascular and cardiovascular death in men (HR for 0.1-unit increase 1.12 [95% CI, 1.04-1.19] for non-CVD deaths and 1.18 [1.09-1.28] for CVD deaths) and women (1.14 [1.07-1.21] and 1.14 [1.06-1.22], respectively). CKD-EPIcr-cyc predicted the risk of CVD deaths in men (HR for 5-unit decrease 1.17 [1.09-1.25]) and women (1.09 [1.02-1.17]) and non-CVD deaths in women (1.07 [1.01-1.14]). Also, MDRD (HR for 5-unit decrease 1.16 [1.05-1.27]) and CKD-EPI (HR for 5-unit decrease 1.15 [1.05-1.25]) predicted CVD deaths among men. After additional adjustments, predictive value of cystatin C remained significant. Also, the predictive value of CKD-EPIcr-cys remained significant in non-CVD deaths among women.
  
  
  CONCLUSIONS
  Cystatin C was clearly the best predictor for cardiovascular and non-cardiovascular deaths among Finnish elderly. Serum cystatin C is more accurate for clinical decision making than creatinine-based eGFR equations or the combined CKD-EPIcr-cys equation in persons older than 64years.
authors.affiliation: Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland; Härkätie Health Centre, Lieto, Finland; City of Turku, Welfare Division, Yliopistonkatu 30, FI-20101, Finland. Electronic address: majosa@utu.fi.
authors.forename: Marika
authors.initials: M
authors.lastname: Salminen
authors.affiliation: Unit of Nephrology, Satakunta Central Hospital, Pori, Finland.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Laine
authors.affiliation: Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland; Satakunta Hospital District, Pori, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Korhonen
authors.affiliation: Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Elise
authors.initials: E
authors.lastname: Wasen
authors.affiliation: Institute of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.affiliation: Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland; City of Vaasa, Social and Health Care, Ruutikellarintie 4, FI-65101, Finland.
authors.forename: Raimo
authors.initials: R
authors.lastname: Isoaho
authors.affiliation: Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland; Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, Helsinki, Finland.
authors.forename: Sirkka-Liisa
authors.initials: SL
authors.lastname: Kivelä
authors.affiliation: Kaarina Health Centre, Voivalantie 5, FI-20781, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Löppönen
authors.affiliation: Institute of Clinical Medicine, Clinical Chemistry, University of Turku, Turku, Finland.
authors.forename: Kerttu
authors.initials: K
authors.lastname: Irjala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: Creatinine; Cystatin C; Elderly; Glomerular filtration rate; Mortality