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Serum concentration of cystatin C and risk of end-stage renal disease in diabetes
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dc.type
JournalArticle
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dc.description.physical
2311-2316
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dc.abstract.en
OBJECTIVEdPatients with diabetes have a high risk of end-stage renal disease (ESRD). We
examined whether prediction of this outcome, according to chronic kidney disease (CKD) staging by creatinine-based estimates of the glomerular filtration rate (eGFRcreat), is improved by
further staging with serum cystatin C–based estimates (eGFRcyst).
RESEARCH DESIGN AND METHODSdPatients with diabetes in CKD stages 1–3 were
selected from three cohorts: two from Joslin Diabetes Center, one with type 1 diabetes (N = 364)
and one with type 2 diabetes (N = 402), and the third from the Finnish Diabetic Nephropathy
(FinnDiane) Study of type 1 (N = 399). Baseline serum concentrations of creatinine and cystatin C
were measured in all patients. Follow-up averaged 8–10 years and onsets of ESRD (n = 246) and
death unrelated to ESRD (n = 159) were ascertained.
RESULTSdAlthough CKD staging by eGFRcyst was concordant with that by eGFRcreat for
62% of Joslin patients and 73% of FinnDiane patients, those given a higher stage by eGFRcyst
than eGFRcreat had a significantly higher risk of ESRD than those with concordant staging in all
three cohorts (hazard ratio 2.3 [95% CI 1.8–3.1]). Similarly, patients at a lower stage by eGFRcyst
than by eGFRcreat had a lower risk than those with concordant staging (0.30 [0.13–0.68]).
Deaths unrelated to ESRD followed the same pattern, but differences were not as large.
CONCLUSIONSdIn patients with diabetes, CKD staging based on eGFRcyst significantly
improves ESRD risk stratification based on eGFRcreat. This conclusion can be generalized to
patients with type 1 and type 2 diabetes and to diabetic patients in the U.S. and Finland.
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dc.description.volume
35
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dc.description.number
11
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dc.identifier.doi
10.2337/dc11-2220
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dc.identifier.eissn
1935-5548
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dc.title.journal
Diabetes Care
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dc.language.container
eng
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dc.affiliation
Wydział Lekarski : Katedra Chorób Wewnętrznych i Medycyny Wsi
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dc.subtype
Article
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dc.rights.original
CC-BY-NC-ND; inne; ostateczna wersja wydawcy; w momencie opublikowania; 0
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