The Association of Intraindividual Difference Between Cystatin- and Creatinine-Based Estimated GFR and Contrast-Associated Acute Kidney Injury

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-03-08 DOI:10.2147/cia.s447042

Li-Wei Zhang, Man-Qing Luo, Ji-Lang Zeng, Zhe-Bin You, Li-Chuan Chen, Jun-Han Chen, Kai-Yang Lin, Yan-Song Guo

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引用次数: 0

Abstract

Purpose: The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI).
Patients and Methods: From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m².
Results: Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between − 15 and 15 mL/min/1.73 m². Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (− 15 to 15 mL/min/1.73 m²), the negative-eGFRdiff group (less than − 15 mL/min/1.73 m²) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57– 4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19– 3.95, P < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19– 4.63, P < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr.
Conclusion: There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.

Keywords: estimated glomerular filtration rate, contrast-associated acute kidney injury, cystatin C, percutaneous coronary intervention

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基于胱抑素和肌酸酐的估计肾小球滤过率个体内差异与对比度相关急性肾损伤的关系

目的：基于肌酐的估计肾小球滤过率（eGFR）对于造影剂相关急性肾损伤（CA-AKI）的风险评估至关重要。最近，基于胱抑素 C 的 eGFR（eGFRcys）与基于肌酐的 eGFR（eGFRcr）之间的差异已被广泛记录。我们旨在探讨 eGFRcys 和 eGFRcr 之间的个体内差异是否对接受择期经皮冠状动脉介入治疗（PCI）患者的 CA-AKI 风险评估具有潜在价值：2012年1月至2018年12月，我们回顾性观察了5049名接受择期PCI的患者。为确定 eGFR，测量了血清肌酐和胱抑素 C 水平。造影剂暴露后 48 小时内血清肌酐升高≥50% 或 0.3 mg/dL 即为 CA-AKI。慢性肾脏病（CKD）定义为 eGFR < 60 mL/min/1.73 m2：约半数参与者（2479 人，49.1%）的基线 eGFRdiff（eGFRcys-eGFRcr）介于-15 和 15 mL/min/1.73 m2 之间。限制性三次样条分析显示，eGFRdiff 与 CA-AKI 之间存在非线性关系。多变量逻辑回归分析表明，与参照组（- 15 至 15 mL/min/1.73 m2）相比，阴性 eGFRdiff 组（小于 - 15 mL/min/1.73 m2）发生 CA-AKI 的风险更高（OR，3.44；95% CI，2.57- 4.64）。此外，根据 eGFRcys 或 eGFRcr 确定的 CKD 将患者分为四组。多变量逻辑分析显示，与无 CKDcys 和 CKDcr 的患者相比，有 CKDcys（OR，2.94；95% CI，2.19- 3.95，P <；0.001）或 CKDcr（OR，2.44；95% CI，1.19- 4.63，P <；0.001）的患者发生 CA-AKI 的风险更高：关键词：估计肾小球滤过率造影剂相关急性肾损伤胱抑素C 经皮冠状动脉介入治疗

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.