Presentation Abstract

Session: 09-Traditional Risk Factors
Friday, Mar 25, 2011, 8:30 AM -10:00 AM
Presentation: 039 - The Impact of CKD Classification by Creatinine Alone vs. Multiple Kidney Markers: Is it Time for a Kidney Panel? The REasons for Geographic and Racial Differences in Stroke (REGARDS) study
Location: Atrium Ballroom A
Pres. Time: Friday, Mar 25, 2011, 9:45 AM -10:00 AM
Category: +EPI - Renal Disease
Keywords: Kidney; Prognosis; Diagnostic techniques
Author(s): Carmen A Peralta, Michael G Shlipak, Univ of California San Francisco, San Francisco, CA; Suzanne Judd, Univ of Alabama Birmigham, Birmingham, AL; Mary Cushman, Univ of Vermont, Burlington, VT; William McClellan, Xiao Zhang, Paul Muntner, David G Warnock, Univ of Alabama Birmingham, Birmingham, AL
Abstract: Clinical laboratories routinely report estimated glomerular filtration rate (eGFR). These estimates by creatinine are unreliable when GFR is >60 ml/min. Classifying persons based on this report may limit the clinician’s ability to identify persons with undetected kidney disease (CKD) until the disease is well established and highly morbid. The impact on risk stratification of a triple-marker panel for CKD using creatinine, cystatin C and albuminuria has not been evaluated.
Among 26,643 REGARDS participants, we estimated eGFR by creatinine (eGFRcreat) and cystatin C (eGFRcys), and calculated the urinary albumin/creatinine ratio (ACR). We estimated the prevalence of CKD (eGFRcreat <60 ml/min/1.73m2). We categorized persons with no CKD by creatinine using eGRcys and ACR and investigated the risk of death for each category over 4.5 years of follow up using Cox models. Using multivariable logistic regression, we investigated factors associated with having undetected CKD by creatinine but identified by cystatin C.
Mean age was 65 years, 40% were black, 54% female, and 11% (N= 2904) had CKD by creatinine. Among persons with no CKD by creatinine, 16% had CKD detected by cystatin C and/or ACR. Among these, having ACR ≥30 or eGFRcys <60 ml/min/1.73m2 was independently and incrementally associated with a higher risk of death. (Table) Age (OR/10years 1.46, (1.32,1.63)), BMI (per 5 kg/m2, OR 1.50 (1.40, 1.61)), current smoking (OR 2.92 (2.29, 3.72)), ACR ≥30 mg/g (OR 2.30 (1.90, 2.80)) hypertension (OR 1.57 (1.29,1.91)), diabetes (1.44 (1.18, 1.74)), and CVD (OR 1.19 (1.01,1.42)) were associated with higher odds of having CKD detected by cystatin C but missed by creatinine.
Undetected CKD is common and can be detected by both Cystatin C and ACR. These identify different subgroups and are independent and incremental risk factors for all-cause mortality. A kidney panel would improve detection of CKD.
Mortality Risk Stratified by Cystatin C and Albuminuria among REGARDS participants with eGFRcreat > 60 ml/min/1.73m2
Disclosures:  C.A. Peralta: None. M.G. Shlipak: None. S. Judd: None. M. Cushman: C. Other Research Support; Significant; Amgen. W. McClellan: C. Other Research Support; Significant; Amgen. X. Zhang: None. P. Muntner: C. Other Research Support; Modest; Amgen. D.G. Warnock: C. Other Research Support; Significant; Amgen.