Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study

Autoři: Joshua Z. Willey aff001;  Yeseon Park Moon aff001;  S. Ali Husain aff002;  Mitchell S. V. Elkind aff001;  Ralph L. Sacco aff004;  Myles Wolf aff005;  Ken Cheung aff006;  Clinton B. Wright aff004;  Sumit Mohan aff002
Působiště autorů: Division of Nephrology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States of America aff001;  Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America aff002;  Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America aff003;  Departments of Neurology and Public Health Sciences, Leonard M. Miller School of Medicine, the McKnight Brain Institute and the Neuroscience Program, University of Miami, Miami, FL, United States of America aff004;  Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America aff005;  Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of renal function. While creatinine-based eGFR (eGFRcr) is widely used in clinical practice, the use of cystatin-C to estimate GFR (eGFRcys) has demonstrated superior risk prediction in various populations. Prior studies that derived eGFR formulas have infrequently included high proportions of elderly, African-Americans, and Hispanics.


Our objective as to compare mortality risk prediction using eGFRcr and eGFRcys in an elderly, race/ethnically diverse population.


The Northern Manhattan Study (NOMAS) is a multiethnic prospective cohort of elderly stroke-free individuals consisting of a total of 3,298 participants recruited between 1993 and 2001, with a median follow-up of 18 years.


We included all Northern Manhattan Study (NOMAS) participants with concurrent measured creatinine and cystatin-C.

Main measures

The eGFRcr was calculated using the CKD-EPI 2009 equation. eGFRcys was calculated using the CKD-EPI 2012 equations. The performance of each eGFR formula in predicting mortality risk was tested using receiver-operating characteristics, calibration and reclassification. Net reclassification improvement (NRI) was calculated based on the Reynolds 10 year risk score from adjusted Cox models with mortality as an outcome. The primary hypothesis was that eGFRcys would better predict mortality than eGFRcr.


Participants (n = 2988) had a mean age of 69±10.2 years and were predominantly Hispanic (53%), overweight (69%), and current or former smokers (53% combined). The mean eGFRcr (74.68±18.8 ml/min/1.73m2) was higher than eGFRcys (51.72±17.2 ml/min/1.73m2). During a mean of 13.0±5.6 years of follow-up, 53% of the cohort had died. The AUC of eGFRcys (0.73) was greater than for eGFRcr (0.67, p for difference<0.0001). The proportions of correct reclassification (NRI) based on 10 year mortality for the model with eGFRcys compared to the model with eGFRcr were 4.2% (p = 0.002).


In an elderly, race/ethnically diverse cohort low eGFR is associated with risk of all-cause mortality. Estimated GFR based on serum cystatin-C, in comparison to serum creatinine, was a better predictor of all-cause mortality.

Klíčová slova:

Creatinine – Curve fitting – Elderly – Geriatric nephrology – Geriatrics – Glomerular filtration rate – Hispanic people – Chronic kidney disease


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