A comparison of cystatin C concentrations between patients with chronic interstitial nephritis and glomerular diseases.

AIMS: Cystatin C have shown to be a renal function parameter with higher sensitivity and specificity than serum creatinine. In tubular diseases, cystatin C degradation and an increase in its urinary elimination would be observed. We have tried to define if different kinds of kidney diseases may significantly affect the serum levels of cystatin C. DESIGN AND METHODS: Four hundred and four patients were studied: 249 men and 155 women, mean age was 64.3±10.1 years. Patients were classified into three groups: (1) Chronic interstitial nephropathy (CIN), (2) Glomerular nephropathy (GN), and (3) Non- CKD patients (control). GFR was estimated though the CKD-EPI equation and the Hoek formula. RESULTS: Median of serum creatinine levels was higher in CIN group than in GN and control groups. Median cystatin C levels were lower in control group compared with CIN and GN groups. No significant differences were found between CIN group and GN group. Nevertheless, the cystatin/creatinine rate was lower in the CIN group patients (0.94, 0.81-1.11) than in the GN group (1.02,I 0.85-1.25) as well as the control group (1.02, I 0.88-1.20). The cystatin C-estimated GFR/creatinine-estimated GFR rate was higher in the CIN group (1.18, 1.03-1.36) than in the GN patients (1.03, 0.88-1.21) and control ones (1.07, 0.88-1.20). CONCLUSIONS: Patients with CIN had lower serum levels of cystatin C defined as cystatin C/creatinine rate when they were compared with GN subject and control ones. In the same way, the index between cystatin C-estimated GFR and creatinine-estimated GFR was higher in CIN patients.

Cistatina C como predictor de mortalidad en población hipertensa de Extremadura / Cystatin C as a mortality predictor in a hypertensive population in Extremadura, Spain

Fundamento y objetivos: La cistatina C ha cobrado importancia en los últimos años como parámetro para medir el riesgo renal y cardiovascular. Sin embargo, existen escasos datos sobre su utilidad en la población española. Hemos realizado el seguimiento de un grupo de pacientes atendidos en Atención Primaria a los cuales se midió este parámetro. Material y métodos: Estudio prospectivo de pacientes atendidos en Atención Primaria de Extremadura en el año 2008 y pr imera mitad de 2009. En total se seleccionaron 142 enfermos, con una edad media de 64,2 ± 14,6 años, siendo el 59,2% varones. En todos los casos se determinó cistatina C y se calculó a partir de esta el filtrado glomerular (FG) por la fórmula de Hoek. También se analizó la creatinina sérica y se estimó el FG mediante la fórmula CKD-EPI. El objetivo primario fue un combinado de la incidencia de muerte y episodios cardiovasculares en la población estudiada. Resultados: En total se produjeron 29 sucesos en el grupo estudiado (20 episodios cardiovasculares, 4 de ellos mortales, y 9 muertes no cardiovasculares). La odds ratio del objetivo combinado fue 5,74 para el último cuartil de la cistatina C (pacientes con cistatina C > 1 mg/l) (p = 0,002), 6,44 para el FG calculado de cistatina C (p = 0,008) y 5,59 para el FG estimado por CKD-EPI (p = 0,002, prueba de Mantel-Haenszel). Conclusiones: La cistatina C mostró una asociación significativa con la mortalidad general y la incidencia de episodios cardiovasculares dentro de la población española. Sin embargo, esta no fue mayor que la estimación de FG a partir de la creatinina (AU)

Background and objectives: Cystatin C has proven to be a useful parameter to evaluate renal and cardiovascular risk. Nevertheless, there are scanty reports on the utility of this test in the Spanish population. We performed a survey in a group of patients followed up in Primary Care settings. Material and methods: Prospective follow up of Primary Care attended patients recruited in 2008 and the first half of 2009. The sample included 142 subjects (mean age 64.2 ± 14.6 years, 59.2% men). In all cases, cystatin C was determined and glomerular filtration rate (GFR) was estimated through the Hoek formula. Serum creatinine was also quantified as it was GFR estimated using CKD-EPI equation. The primary objective was a combination of death and major cardiovascular events incidence. Results: There were 29 events registered (4 of them were deaths) and 9 non cardiovascular deaths. The odds ratio for the primary objective was 5.74 for the last quartile of cystatin C distribution (> 1 mg/l) (P = .002), while it was 6.44 for cystatin C derived GFR (P = .008) and 5.59 for CKD-EPI estimated GFR (P = .002, Mantel-Haenszel test). Conclusions: Cystatin C showed a good association with general mortality and the incidence of cardiovascular events in the Spanish population. Nevertheless, it was not better than the observed relationship with GFR, estimated from creatinine (AU)

[Cystatin C as a mortality predictor in a hypertensive population in Extremadura, Spain]. / Cistatina C como predictor de mortalidad en población hipertensa de Extremadura.

BACKGROUND AND OBJECTIVES: Cystatin C has proven to be a useful parameter to evaluate renal and cardiovascular risk. Nevertheless, there are scanty reports on the utility of this test in the Spanish population. We performed a survey in a group of patients followed up in Primary Care settings. MATERIAL AND METHODS: Prospective follow up of Primary Care attended patients recruited in 2008 and the first half of 2009. The sample included 142 subjects (mean age 64.2±14.6 years, 59.2% men). In all cases, cystatin C was determined and glomerular filtration rate (GFR) was estimated through the Hoek formula. Serum creatinine was also quantified as it was GFR estimated using CKD-EPI equation. The primary objective was a combination of death and major cardiovascular events incidence. RESULTS: There were 29 events registered (4 of them were deaths) and 9 non cardiovascular deaths. The odds ratio for the primary objective was 5.74 for the last quartile of cystatin C distribution (>1mg/l) (P=.002), while it was 6.44 for cystatin C derived GFR (P=.008) and 5.59 for CKD-EPI estimated GFR (P=.002, Mantel-Haenszel test). CONCLUSIONS: Cystatin C showed a good association with general mortality and the incidence of cardiovascular events in the Spanish population. Nevertheless, it was not better than the observed relationship with GFR, estimated from creatinine.

Estimated glomerular filtration rate from serum cystatin C: significant differences among several equations results.

OBJECTIVES: Several equations for the estimation of glomerular filtration rate (GFR) from serum cystatin C have been reported. We compared the results obtained using these equations to test the homogeneity of their results as well as their usefulness in clinical practice. DESIGN AND METHODS: Seven hundred and twenty-seven outpatients were studied. Of these, 439 were male and 288 were female, and their mean age was 60.8 ± 24.1 years. GFR was estimated from serum creatinine using the abbreviated Modification of Diet in Renal Disease (MDRD-4) equation. GFR was estimated from serum cystatin C levels using five different equations. RESULTS: The simplest (100/cystatin C) formula rendered the highest estimated GFR and the Hoek's equation rendered the lowest GFR, even significantly lower than the MDRD-4 equation (p < 0.001, Student's t-test). From the simplest formula to the Hoek equation the mean difference calculated was 25.1 ± 8.7 mL/min (p < 0.001, Student's t-test). No differences by gender were found among the results of different equations. All cystatin C-derived equations reduced the number of patients diagnosed of chronic renal failure when compared with MDRD-4 formula. No patient with normal renal function was shifted to the renal disease group. CONCLUSIONS: A higher value could be expected when GFR is estimated from cystatin C. Nevertheless, vast differences were found in the results when tested using several equations. Physicians should be aware of this problem to avoid a wrong clinical diagnosis of renal function.

Symmetrical Ambulatory Arterial Stiffness Index: relationship with serum cystatin C levels.

OBJECTIVE: Increased central arterial stiffening is the consequence of many disease states such as diabetes, atherosclerosis, and chronic renal disease. Symmetrical Ambulatory Arterial Stiffness Index (Sym-AASI) may provide a simple clinical approach to evaluate arterial stiffness. This study has tried to evaluate the relationship of Sym-AASI with cystatin C levels. DESIGN AND METHODS: The sample subjects were 53 males and 34 females (mean age = 59.3 ± 13.5 years). Kidney function was evaluated by measuring serum cystatin C and estimated glomerular filtration rate (eGFR). The ambulatory BP was measured noninvasively for 24 h. RESULTS: Patients in the highest quartile showed an older age (p < 0.001) and worse eGFR (p < 0.001). Pulse pressure (PP) increased as cystatin C was higher. Mean Sym-AASI showed an increase from the first to the last cystatin C quartile. Correlation test showed a significant relationship of Sym-AASI with age (r = 0.573), serum creatinine (r = 0.237), eGFR (-0.323), cystatin C (r = 0.427), systolic blood pressure (r = 0.525), and PP (r = 0.647). Multivariate regression analysis showed that age, cystatin C, nocturnal systolic blood pressure reduction, and nocturnal diastolic blood pressure fall were independently related to Sym-AASI. There was not any independent association between eGFR and Sym-AASI or between cystatin C and PP. CONCLUSIONS: Increased Sym-AASI seems to be independently associated with serum cystatin C levels. Sym-AASI seems to be better than PP to detect changes in the arterial wall. This could be a simple and easy method to evaluate arterial stiffness in hypertensive patients without needing more complex devices.

[Microalbuminuria-related cardiovascular risk in diabetic patients and hypertensive (non diabetic) population]. / Riesgo cardiovascular asociado a microalbuminuria en pacientes diabéticos y en pacientes con hipertensión arterial.

BACKGROUND AND OBJECTIVE: The MICREX Study has shown an high prevalence of microalbuminuria in Extremadura among diabetic patients and hypertensive population. It has been retrospectively evaluated the cardiovascular risk associated to microalbuminuria and/or diabetes mellitus. PATIENTS AND METHOD: A total of 902 patients older than 18 years were studied (mean age, 68.7 [11.0] years; 370 men and 532 women; 469 were diabetics and 433 non diabetic hypertensives). Microalbuminuria was measured in every patient using albumin/creatinin reactive stick in fasting first morning urine. Anthropometric measures and previous cardiovascular diseases were recorded. RESULTS: Odds ratio of cardiovascular disease for all patients with microalbuminuria was 1.91 (confidence interval [CI] 95%, 1.31-2.78; p = 0.001), for diabetic group it was 1.87 (CI 95%, 1.15-3.04; p = 0.01) and for non diabetic hypertensives 1.78 (CI 95%, 0.98-3.30; p = 0.06). The risk associated to all patients with diabetes mellitus (versus non diabetic hypertensives) showed an odds ratio = 1.59 (CI 95%, 1.19-2.14; p = 0.02). Hypertension in diabetic subjects rises odds ratio up to 2.13 (CI 95%, 1.30-3.48; p = 0.002). When hypertensives diabetics were compared to non diabetic hypertensives odds ratio was 1.88 (CI 95%, 1.37-2.57; p < 0.0001). CONCLUSIONS: In a retrospective view microalbuminuria and diabetes mellitus were positively related to a higher risk of cardiovascular disease. Microalbuminuria and/or hypertension in diabetic patients were also associated to higher cardiovascular risk.

Riesgo cardiovascular asociado a microalbuminuria en pacientes diabéticos y en pacientes con hipertensión arterial / Microalbuminuria-related cardiovascular risk in diabetic patients and hypertensive (non diabetic) population

Fundamento y objetivo: El estudio MICREX ha demostrado que la microalbuminuria es un problema de gran prevalencia en Extremadura. Se ha valorado retrospectivamente la aparición de complicaciones cardiovasculares clínicas o subclínicas en los pacientes estudiados (diabéticos y/o hipertensos), calculando su riesgo en función de que tuvieran microalbuminuria y/o diabetes mellitus o no las tuvieran. Pacientes y método: Para el análisis se ha utilizado los datos de 902 pacientes, con una media (desviación estándar) de edad de 68,7 (11) años; 370 eran varones y 532, mujeres; 469 eran diabéticos y 433, hipertensos sin diabetes. De cada paciente se realizó una determinacion con tira semicuantitativa de albuminuria/creatininuria en muestra de orina de primera hora de la mañana y en ayunas. En todos los casos se realizaron mediciones antropométricas y se registraron las enfermedades cardiovasculares asociadas. Resultados: La odds ratio (OR) del riesgo de tener complicaciones cardiovasculares por microalbuminuria fue de 1,91 (intervalo de confianza [IC] del 95%, 1,31-2,78; p = 0,001) en el total de la muestra; para los diabéticos, 1,87 (IC del 95%, 1,15-3,04; p = 0,01) y para los hipertensos, 1,78 (IC del 95%, 0,98-3,30; p = 0,06). El riesgo asociado a diabetes mellitus mostraba una OR = 1,59 (IC del 95%, 1,19-2,14; p = 0,02). La hipertensión arterial en los enfermos diabéticos aumentaba la OR a 2,13 (IC del 95%, 1,30-3,48; p = 0,002). Cuando se comparó a los diabéticos hipertensos con los hipertensos sin diabetes, la OR era 1,88 (IC del 95%, 1,37-2,57; p < 0,0001). Conclusiones: Valoradas de forma retrospectiva, la microalbuminuria y la diabetes mellitus tienen relación directa con un riesgo de enfermedades cardiovasculares aumentado. La microalbuminuria y/o la hipertensión arterial en un paciente diabético también tienen relación con mayor riesgo cardiovascular

Background and objective: The MICREX Study has shown an high prevalence of microalbuminuria in Extremadura among diabetic patients and hypertensive population. It has been retrospectively evaluated the cardiovascular risk associated to microalbuminuria and/or diabetes mellitus. Patients and method: A total of 902 patients older than 18 years were studied (mean age, 68.7 [11.0] years; 370 men and 532 women; 469 were diabetics and 433 non diabetic hypertensives). Microalbuminuria was measured in every patient using albumin/creatinin reactive stick in fasting first morning urine. Anthropometric measures and previous cardiovascular diseases were recorded. Results: Odds ratio of cardiovascular disease for all patients with microalbuminuria was 1.91 (confidence interval [CI] 95%, 1.31-2.78; p = 0.001), for diabetic group it was 1.87 (CI 95%, 1.15-3.04; p = 0.01) and for non diabetic hypertensives 1.78 (CI 95%, 0.98-3.30; p = 0.06). The risk associated to all patients with diabetes mellitus (versus non diabetic hypertensives) showed an odds ratio = 1.59 (CI 95%, 1.19-2.14; p = 0.02). Hypertension in diabetic subjects rises odds ratio up to 2.13 (CI 95%, 1.30-3.48; p = 0.002). When hypertensives diabetics were compared to non diabetic hypertensives odds ratio was 1.88 (CI 95%, 1.37-2.57; p < 0.0001). Conclusions: In a retrospective view microalbuminuria and diabetes mellitus were positively related to a higher risk of cardiovascular disease. Microalbuminuria and/or hypertension in diabetic patients were also associated to higher cardiovascular risk

Microalbuminuria en pacientes diabéticos y en pacientes con hipertensión arterial: estudio de una cohorte de 979 pacientes / Microalbuminuria in diabetic and hypertensive patients: a study of 979 patients

Fundamento y objetivo: Aunque la microalbuminuria es una complicación conocida de la diabetes mellitus, también es un factor de riesgo cardiovascular presente en población hipertensa sin diabetes mellitus. Su prevalencia es variable según las zonas estudiadas y nunca se la ha examinado en Extremadura. El estudio MICREX ha intentado estimar la prevalencia de este problema en nuestra región. Pacientes y método: Se incluyó en el estudio a pacientes diabéticos o hipertensos que no fueran diabéticos seleccionados aleatoriamente. De cada paciente, se realizó una medición con tira semicuantitativa de albuminuria/creatininuria en muestra de orina de primera hora de la mañana y en ayunas. Siempre que fue posible, se complementó con la cuantificación de microalbuminuria y creatinina en orina de primera hora de la mañana. Resultados: Se ha incluido a 979 pacientes (media de edad [desviación estándar], 67,9 [10,8] años; 409 varones y 570 mujeres), de los que 505 eran diabéticos. Un 12,4% de los hipertensos presentaban microalbuminuria, frente al 21,4% de los diabéticos (p < 0,001). La tasa de microalbuminuria de hipertensos y diabéticos normotensos era parecida (13,3%, no significativa), pero se triplicaba en los diabéticos hipertensos (33,8%; p < 0,01). No hubo diferencias en el control glucémico entre diabéticos con microalbuminuria y quienes no la presentaban. La prevalencia de microalbuminuria no era menor en los pacientes tratados con fármacos antagonistas del eje renina-angiotensina (diabéticos, 23,5%; hipertensos, 10,5%). El resultado de la tira reactiva se confirmó mediante determinación en laboratorio en el 65,4% de los casos. Conclusiones: La microalbuminuria es de elevada prevalencia en Extremadura, tanto en diabéticos como en pacientes no diabéticos. La microalbuminuria en diabéticos se correlaciona con la hipertensión arterial, pero no con el control glucémico. A pesar del tratamiento con antagonistas del eje renina-angiotensina, la prevalencia de microalbuminuria es elevada

Background and objective: Microalbuminuria is a known complication of diabetes mellitus but it is also a cardiovascular risk factor commonly present among hypertensive (non diabetic) population. The prevalence of microalbuminuria is variable and it has been never estimated in our region. The aim of this study has been to determine the prevalence of microalbuminuria in hypertensive (non diabetic) and diabetic population in Extremadura (Spain). Patients and method: The study included diabetic patients and non-diabetic hypertensive ones randomly selected. Microalbuminuria was measured in every patient using albumin/creatinin reactive stick in fasting first morning urine. Whenever possible microalbuminuria was confirmed in laboratory by microalbuminuria/creatinina coefficient in first morning urine samples. Results: A total of 979 patients (mean age [SD], 67.9 [10.8] years; 409 men and 570 women, 505 diabetics) were studied. The presence of microalbuminuria was found in 12.4% of hypertensive patients and in 21.4% of diabetic patients (p < 0.001). Hypertensives and normotensive diabetics showed a similar prevalence of microalbuminuria (13.3%, not significant), but it tripled in hypertensive diabetics (33.8; p < 0.01). Glicemic control was not different for microalbuminuric diabetic patients and non microalbuminuric ones. The patients receiving rennin-angiotensin axis blocking drugs do not showed less prevalence of microalbuminuria (hypertensives 10.5%, diabetics 23.5%). Microalbuminuria was confirmed in 65.4% of patients. Conclusions: The prevalence of microalbuminuria in Extremadura seems to be high either in diabetics or non diabetic hypertensive patients. The finding of microalbuminuria in diabetics patients correlates with hypertension but do not with glicemic control. The prevalence of microalbuminuria is high in spite of using rennin-angiotensin axis blocking drugs

[Microalbuminuria in diabetic and hypertensive patients: a study of 979 patients]. / Microalbuminuria en pacientes diabéticos y en pacientes con hipertensión arterial: estudio de una cohorte de 979 pacientes.

BACKGROUND AND OBJECTIVE: Microalbuminuria is a known complication of diabetes mellitus but it is also a cardiovascular risk factor commonly present among hypertensive (non diabetic) population. The prevalence of microalbuminuria is variable and it has been never estimated in our region. The aim of this study has been to determine the prevalence of microalbuminuria in hypertensive (non diabetic) and diabetic population in Extremadura (Spain). PATIENTS AND METHOD: The study included diabetic patients and non-diabetic hypertensive ones randomly selected. Microalbuminuria was measured in every patient using albumin/creatinin reactive stick in fasting first morning urine. Whenever possible microalbuminuria was confirmed in laboratory by microalbuminuria/creatinina coefficient in first morning urine samples. RESULTS: A total of 979 patients (mean age [SD], 67.9 [10.8] years; 409 men and 570 women, 505 diabetics) were studied. The presence of microalbuminuria was found in 12.4% of hypertensive patients and in 21.4% of diabetic patients (p < 0.001). Hypertensives and normotensive diabetics showed a similar prevalence of microalbuminuria (13.3%, not significant), but it tripled in hypertensive diabetics (33.8; p < 0.01). Glicemic control was not different for microalbuminuric diabetic patients and non microalbuminuric ones. The patients receiving rennin-angiotensin axis blocking drugs do not showed less prevalence of microalbuminuria (hypertensives 10.5%, diabetics 23.5%). Microalbuminuria was confirmed in 65.4% of patients. CONCLUSIONS: The prevalence of microalbuminuria in Extremadura seems to be high either in diabetics or non diabetic hypertensive patients. The finding of microalbuminuria in diabetics patients correlates with hypertension but do not with glicemic control. The prevalence of microalbuminuria is high in spite of using rennin-angiotensin axis blocking drugs.