Endocrinol Metab.  2016 Sep;31(3):446-453. 10.3803/EnM.2016.31.3.446.

Prevalence of Reduced Kidney Function by Estimated Glomerular Filtration Rate Using an Equation Based on Creatinine and Cystatin C in Metabolic Syndrome and Its Components in Korean Adults

• Kang YH
• Jeong DW
• Son SM

• KMID: 2352985
• DOI: http://doi.org/10.3803/EnM.2016.31.3.446

Abstract

BACKGROUND
It is known that metabolic syndrome (MetS) is associated with chronic kidney disease. We evaluated and compared the prevalence of reduced kidney function in MetS and its components by estimated glomerular filtration rate (eGFR) using an equation based on creatinine (eGFRcr), cystatin C (eGFRcys), and combined creatinine-cystatin C (eGFRcr-cys) in Korean adults.
METHODS
We analyzed data from 3,649 adults who participated in a comprehensive health examination.
RESULTS
Mean values of eGFRcys were higher compared with mean values of eGFRcr (96.1±18.2 mL/min/1.73 m² vs. 91.2±13.6 mL/min/1.73 m²) in total subjects. The prevalence of reduced kidney function increased with age (9.6% for eGFRcys vs. 5.8% for eGFRcr-cys vs. 4.9% for eGFRcr, in subjects aged ≥60 years), and significantly increased with MetS, abdominal obesity, hypertension, high triglyceride, low high density lipoprotein (HDL), and high insulin resistance. The prevalence of MetS, abdominal obesity, hypertension, high insulin resistance, low HDL, and hepatic steatosis was significantly increased in subjects with reduced kidney function. This increased prevalence and the odds ratio of reduced kidney function for prevalence of MetS was highest for eGFRcys, followed by those of eGFRcr-cys, and eGFRcr.
CONCLUSION
The prevalence of reduced kidney function by eGFR was significantly increased in subjects with MetS and its related components. eGFRcys and eGFRcr-cys were superior to eGFRcr in detecting reduced kidney function.

Keyword

Glomerular filtration rate; Cystatin C; Creatinine; Metabolic syndrome

MeSH Terms

Adult*
Creatinine*
Cystatin C*
Glomerular Filtration Rate*
Humans
Hypertension
Insulin Resistance
Kidney*
Lipoproteins
Obesity, Abdominal
Odds Ratio
Prevalence*
Renal Insufficiency, Chronic
Triglycerides
Creatinine
Cystatin C
Lipoproteins

Figure

• 

  Fig. 1 Prevalence of metabolic syndrome and its components between reduced kidney function and preserved kidney function by estimated glomerular filtration rate (eGFR) based on creatinine (eGFRcr), cystatin C (eGFRcys), and combined creatinine-cystatin C (eGFRcr-cys). (A) Metabolic syndrome, (B) abdominal obesity, (C) hypertension, (D) high fasting glucose, (E) low high density lipoprotein (HDL), (F) high triglyceride, (G) high insulin resistance, and (H) hepatic steatosis. P value was calculated by chi-square test. aP<0.05 vs. eGFRcr <60 mL/min/1.73 m2; bP<0.05 vs. eGFRcys <60 mL/min/1.73 m2; cP<0.05 vs. eGFRcr-cys <60 mL/min/1.73 m2.

Reference

1. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005; 366:1059–1062.

2. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care. 2005; 28:1769–1778.

3. Obunai K, Jani S, Dangas GD. Cardiovascular morbidity and mortality of the metabolic syndrome. Med Clin North Am. 2007; 91:1169–1184.

4. Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med. 2004; 140:167–174.

5. Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol. 2005; 16:2134–2140.

6. Kanauchi M, Kanauchi K, Kimura K, Inoue T, Saito Y. Associations of chronic kidney disease with the metabolic syndrome in non-diabetic elderly. Nephrol Dial Transplant. 2006; 21:3608–3609.

7. Ferguson MA, Waikar SS. Established and emerging markers of kidney function. Clin Chem. 2012; 58:680–689.

8. Chew-Harris JS, Florkowski CM, George PM, Elmslie JL, Endre ZH. The relative effects of fat versus muscle mass on cystatin C and estimates of renal function in healthy young men. Ann Clin Biochem. 2013; 50(Pt 1):39–46.

9. Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem. 2002; 48:699–707.

10. Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012; 367:20–29.

11. Tangri N, Stevens LA, Schmid CH, Zhang YL, Beck GJ, Greene T, et al. Changes in dietary protein intake has no effect on serum cystatin C levels independent of the glomerular filtration rate. Kidney Int. 2011; 79:471–477.

12. Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int. 2009; 75:652–660.

13. Tsai CW, Grams ME, Inker LA, Coresh J, Selvin E. Cystatin C- and creatinine-based estimated glomerular filtration rate, vascular disease, and mortality in persons with diabetes in the U.S. Diabetes Care. 2014; 37:1002–1008.

14. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150:604–612.

15. Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008; 51:395–406.

16. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–2497.

17. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752.

18. Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents: National Health and Nutrition Examination Survey 2005-2006. Diabetes Care. 2009; 32:342–347.

19. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006; 6:33.

20. Bedogni G, Kahn HS, Bellentani S, Tiribelli C. A simple index of lipid overaccumulation is a good marker of liver steatosis. BMC Gastroenterol. 2010; 10:98.

21. Grams ME, Juraschek SP, Selvin E, Foster MC, Inker LA, Eckfeldt JH, et al. Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. Am J Kidney Dis. 2013; 62:253–260.

22. Pattaro C, Riegler P, Stifter G, Modenese M, Minelli C, Pramstaller PP. Estimating the glomerular filtration rate in the general population using different equations: effects on classification and association. Nephron Clin Pract. 2013; 123:102–111.

23. Vupputuri S, Fox CS, Coresh J, Woodward M, Muntner P. Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index. Am J Kidney Dis. 2009; 53:993–1001.

24. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007; 298:2038–2047.

25. Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, et al. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med. 2005; 352:2049–2060.

26. Sarnak MJ, Katz R, Stehman-Breen CO, Fried LF, Jenny NS, Psaty BM, et al. Cystatin C concentration as a risk factor for heart failure in older adults. Ann Intern Med. 2005; 142:497–505.

27. Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, et al. Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med. 2006; 145:237–246.

28. Marwyne MN, Loo CY, Halim AG, Norella K, Sulaiman T, Zaleha MI. Estimation of glomerular filtration rate using serum cystatin C in overweight and obese subjects. Med J Malaysia. 2011; 66:313–317.

29. Franca AK, Dos Santos AM, Salgado JV, Hortegal EV, da Silva AA, Salgado Filho N. Estimated visceral adipose tissue, but not body mass index, is associated with reductions in glomerular filtration rate based on cystatin C in the early stages of chronic kidney disease. Int J Nephrol. 2014; 2014:574267.

30. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002; 40:221–226.

31. Herget-Rosenthal S, Bokenkamp A, Hofmann W. How to estimate GFR-serum creatinine, serum cystatin C or equations? Clin Biochem. 2007; 40:153–161.

32. Singh AK, Kari JA. Metabolic syndrome and chronic kidney disease. Curr Opin Nephrol Hypertens. 2013; 22:198–203.

33. Bhowmik D, Tiwari SC. Metabolic syndrome and chronic kidney disease. Indian J Nephrol. 2008; 18:1–4.

34. Tarantino G, Saldalamacchia G, Conca P, Arena A. Non-alcoholic fatty liver disease: further expression of the metabolic syndrome. J Gastroenterol Hepatol. 2007; 22:293–303.

35. Marcuccilli M, Chonchol M. NAFLD and chronic kidney disease. Int J Mol Sci. 2016; 17.

36. Sahakyan K, Lee KE, Shankar A, Klein R. Serum cystatin C and the incidence of type 2 diabetes mellitus. Diabetologia. 2011; 54:1335–1340.

37. Sim EH, Lee HW, Choi HJ, Jeong DW, Son SM, Kang YH. The association of serum cystatin C with glycosylated hemoglobin in Korean adults. Diabetes Metab J. 2016; 40:62–69.