Difference between cystatin C- and creatinine-based estimated glomerular filtration rate and risk of frailty: Mediating role of high-sensitivity C-reaction protein in older adults

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-07-26 DOI:10.1016/j.clnesp.2025.07.1112

Fan Zhang , Yuanjing Zhao , Yan Bai , Liuyan Huang , Jiao Li , Yifei Zhong

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Abstract

Background and aims

This cross-sectional study aims to investigate the difference in estimated glomerular filtration rate (eGFR_diff) based on cystatin c and creatinine and risk of frailty among elderly individuals and to explore the mediating role of high-sensitivity C-reactive protein (hs-CRP).

Methods

eGFR_diff was calculated using both absolute difference (eGFR_diff _absolute) and ratio (eGFR_diff _relative) between cystatin C- and creatinine-based calculations. Frailty status was assessed by the frailty index ranging from 0 to 100 and frailty was defined as ≥ 25. We employed logistic regression models to examine the association between different eGFR_diff measures and frailty risk, adjusting for sociodemographic factors, lifestyle, and health status. Restricted cubic spline for fitting the nonlinear association between eGFR_diff and frailty status. The mediating role of hs-CRP was explored using mediation analysis.

Results

Our analysis included 4989 participants with a median age of 66 years. Approximately 25 % of participants were identified with a frailty condition. In the fully adjusted model, each 15-unit higher eGFR_{diff absolute} was associated with 17.0 % lower odds of prevalent frailty (odds ratio [OR] = 0.830; 95 % confidence interval [95 % CI]: 0.768, 0.897), for each 10 % increase in eGFR_{diff relative}, the corresponding OR was 0.383 (95 % CI: 0.267, 0.549). Compared with participants with similar eGFR_diff (i.e., −15< eGFR_{diff absolute} <15 mL/min/1.73 m²), participants in the negative group (i.e., < −15 mL/min/1.73 m²) were associated with 61.9 % higher odds of prevalent frailty (OR = 1.619; 95 % CI: 1.353, 1.937). Compared with participants with eGFR_{diff relative} <0.6, participants with ≥0.6 were associated with a 56.2 % lower incidence of frailty (OR = 0.438; 95 % CI: 0.304, 0.634). The magnitude of associations was not materially altered in all sensitivity analyses. eGFR_diff was significantly associated with elevated hs-CRP, and elevated hs-CRP was significantly associated with increased risk of frailty. 5.2 % (95 % CI: 1.4 %, 13.9 %) of eGFR_diff-associated frailty was significantly associated with elevated hs-CRP.

Conclusions

Negative eGFR_diff was significantly associated with a higher risk of frailty, and the eGFR_diff-associated frailty risk may be partially mediated by hs-CRP. Further research is needed to explore the underlying mechanisms and validate these findings in diverse populations.

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基于胱抑素C和肌酐的肾小球滤过率和衰弱风险的差异：高敏C反应蛋白在老年人中的中介作用

背景与目的：本横断研究旨在探讨基于胱抑素c和肌酐的估算肾小球滤过率（eGFRdiff）与老年人衰弱风险的差异，并探讨高敏c反应蛋白（hs-CRP）在其中的调节作用。方法：采用胱抑素C和肌酐的绝对差值（eGFRdiffabsolute）和比值（eGFRdiffrelative）计算eGFRdiff。以衰弱指数0 ~ 100评价衰弱状态，衰弱定义为≥25。在调整了社会人口因素、生活方式和健康状况后，我们采用logistic回归模型来检验不同eGFRdiff指标与脆弱风险之间的关系。限制三次样条用于拟合eGFRdiff与脆弱状态之间的非线性关联。采用中介分析探讨hs-CRP的中介作用。结果：我们的分析包括4989名参与者，中位年龄为66岁。大约25%的参与者被确定为身体虚弱。在完全调整后的模型中，eGFRdiff绝对值每提高15个单位，普遍虚弱的几率降低17.0%(优势比[OR]=0.830；95%可信区间[95% CI]: 0.768, 0.897)，相对eGFRdiff每增加10%，相应OR为0.383 （95% CI: 0.267, 0.549）。与eGFRdiff相似（即-15< eGFRdiff绝对值2）的参与者相比，阴性组（即< -15 mL/min/1.73 m2）的参与者普遍虚弱的几率高出61.9% (OR=1.619；95% ci: 1.353, 1.937)。与eGFRdiff患者相比，相对diff与hs-CRP升高显著相关，hs-CRP升高与虚弱风险增加显著相关。5.2% （95% CI: 1.4%, 13.9%）的egfrdiffi相关虚弱与hs-CRP升高显著相关。结论：eGFRdiff阴性与较高的衰弱风险显著相关，eGFRdiff相关的衰弱风险可能部分由hs-CRP介导。需要进一步的研究来探索潜在的机制，并在不同的人群中验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.