Association of Cystatin C-Based Glomerular Filtration Rate with SYNTAX Score in Patients with Diabetes

Abstract

Aim:

Serum cystatin C has been proposed as a better marker of glomerular filtration rate than serum creatinine. SYNTAX score (SXscore) can accurately reflect the severity of coronary artery disease (CAD). However, the association between Cystatin C-based glomerular filtration rate (eGFR_cys) and SXscore in patients with diabetes has never been reported.

Methods:

We prospectively included 656 consecutive patients with diabetes who were angiographically diagnosed with CAD from January 2010 to December 2011. Renal function was assessed by eGFR_cys. SXscore was calculated using SXscore algorithm. Ordinal logistic regression and Pearson correlation were used to analyze the association between eGFR_cys and SXscore.

Results:

Patients with renal dysfunction were older, more often female, more likely to have a history of hypertension and less tobacco use when compared with those patients with normal renal function. Age, sex, SBP, DBP, fasting glucose, HbA_1c, TC, LDL, HDL, TG, BMI and CRP were not different among SXscore tertile groups. Incidence of hypertension, hyperlipidemia, family history and tobacco use were similar among these groups. Correlation analysis suggested that eGFR_cys was negatively correlated with SXscore (R=−0.255, P<0.001). Ordinal logistic regression showed that eGFR_cys was an independent predictor of SXscore (β=−0.027, P<0.001).

Conclusions:

eGFR_cys was an independent predictor of SXscore in patients with diabetes. This might help explain the increased risk of CVD events and mortality in patients with renal dysfunction. Further prospectively multiple centre studies are required to better quantify this finding.

Key words

glomerular filtration rate - cystatin C - chronic kidney disease - coronary artery disease - SYNTAX score - diabetes

• References

• 1 Matsushita K, van der Velde M, Astor BC et al. Association of estimated glomerular filtration rate and albuminuria with all cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375: 2073-2081
• 2 Kottgen A, Russell SD, Loehr LR et al. Reduced kidney function as a risk factor for incident heart failure: the Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol 2007; 18: 1307-1315
• 3 Debella YT, Giduma HD, Light RP et al. Chronic kidney disease as a coronary disease equivalent – a comparison with diabetes over a decade. Clin J Am Soc Nephrol 2011; 6: 1385-1392
• 4 Macisaac RJ, Premaratne E, Jerums G. Estimating Glomerular Filtration Rate in Diabetes Using Serum Cystatin C. Clin Biochem Rev 2011; 32: 61-67
• 5 Coll E, Botey A, Alvarez L et al. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000; 36: 29-34
• 6 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
• 7 Hojs R, Bevc S, Antolinc B et al. Serum cystatin C as an endogenous marker of renal function in the elderly. Int J Clin Pharm 2004; 24: 49-54
• 8 Hojs R, Bevc S, Ekart R et al. Serum cystatin C as an endogenous marker of renal function in patients with mild to moderate impaired kidney function. Nephrol Dial Transplant 2006; 21: 1855-1862
• 9 Bevc S, Hojs R, Ekart R et al. Simple Cystatin C Formula Compared to Sophisticated CKD-EPI Formulas for Estimation of Glomerular Filtration Rate in the Elderly. Ther Apher Dial 2011; 15: 261-268
• 10 MacIsaac RJ, Tsalamndris C, Thomas MC et al. Estimating glomerular filtration rate in diabetes: a comparison of cystatin C and creatinine-based methods. Diabetologia 2006; 49: 1686-1689
• 11 Rule AD, Bregstraalh EJ, Slezak JM et al. Glomerular filtration rate estimated by cystatin C among different clinical presentations. Kidney Int 2006; 69: 399-405
• 12 Hojs R, Bevc S, Ekart R et al. Serum cystatin C-based equation compared to serum creatinine based equations for estimation of glomerular filtration rate in patients with chronic kidney disease. Clin Nephrol 2008; 70: 10-17
• 13 Tidman M, Sjostrom P, Jones I. A comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and combination of the two. Nephrol Dial Transplant 2008; 23: 154-160
• 14 Levey AS. Measurement of renal function in chronic renal disease. Kidney Int 1990; 38: 167
• 15 Gaspari F, Ferrari S, Stucchi N et al. Performance of different prediction equations for estimating renal function in kidney transplantation. Am J Transplant 2004; 4: 1826-1835
• 16 White C, Akbari A, Hussain N et al. Estimating glomerular filtration rate in kidney transplantation: a comparison between serum creatinine and cystatin C-based methods. J Am Soc Nephrol 2005; 16: 3763-3770
• 17 Malheiro J, Fonseca I, Martins LS et al. A comparison between serum creatinine and cystatin C-based equations for estimation of graft function. Transplant Proc 2012; 44: 2352-2356
• 18 Woodward RS, Schnitzler MA, Baty J et al. Incidence and cost of new onser diabetes mellitus among US wait-listed and transplanted renal allograft recipients. Am J Transplant 2003; 3: 590-598
• 19 Vincenti F, Friman S, Scheuermann E et al. Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant 2007; 7: 1506-1574
• 20 Baid S, Cosimi AB, Farrell ML et al. Posttransplant diabetes mellitus in liver transplant recipients: Risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation 2001; 72: 1066-1072
• 21 Kamar N, Toupance O, Buchler M et al. Evidence that clearance of hepatitis C virus RNA after alpha-interferon therapy in dialysis patients is sustained after renal transplantation. J Am Soc Nephrol 2003; 14: 2092-2098
• 22 Sianos G, Morel MA, Kappetein AP et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. Eurointervention 2005; 1: 219-227
• 23 Serruys P, Onuma Y, Garg S et al. Assessment of the SYNTAX score in the Syntax study. Eurointervention 2009; 5: 50-56
• 24 Valgimigli M, Serruys PW, Tsuchida K et al. Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention. Am J Cardiol 2007; 99: 1072-1078
• 25 Serruys PW, Morice MC, Kappetein AP et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360: 961-972
• 26 Serruys P, Onuma Y, Garg S et al. 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 2010; 55: 1093-1101
• 27 Capodanno D, Di Salvo ME, Cincotta G et al. Usefulness of the SYNTAX Score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circ Cardiovasc Interv 2009; 2: 302-308
• 28 Van Gaal WJ, Ponnuthurai FA, Selvanayagam J et al. The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol 2009; 135: 60-65
• 29 Yan LQ, Guo LJ, Zhang FC et al. The relationship between kidney function and angiographically-derived SYNTAX score. Can J Cardiol 2011; 27: 768-772
• 30 Stevens LA, Coresh J, Schmid CH 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
• 31 Inker LA, Eckfeldt J, Levey AS et al. Expressing the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) cystatin C equations for estimating GFR with standardized serum cystatin C values. Am J Kidney Dis 2011; 58: 682-684
• 32 Schrier RW. Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor?. J Am Coll Cardiol 2006; 47: 1-8
• 33 Sarnak MJ, Levey AS, Schoolwerth AC et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003; 108: 2154-2169
• 34 Roos JF, Doust J, Tett SE et al. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children – a meta-analysis. Clin Biochem 2007; 40: 383-391
• 35 Hojs R, Bevc S, Ekart R et al. Serum cystatin C-based formulas for prediction of glomerular filtration rate in patients with chronic kidney disease. Nephron Clin Pract 2010; 114: c118-c126
• 36 Wykrzykowska J, Garg S, Girasis C et al. Value of the Syntax Score (SX) for risk assessment in the “Allcomers” Population of the Randomized Multicenter Leaders Trial. J Am Coll Cardiol 2010; 56: 272-277
• 37 Kilickesmez KO, Abaci O, Okcun B et al. Chronic kidney disease as a predictor of coronary lesion morphology. Angiology 2010; 61: 344-349
• 38 Abaci A, Sen N, Yazici H et al. Renal dysfunction is the most important predictor of the extent and severity of coronary artery disease in patients with diabetes mellitus. Coron Artery Dis 2007; 18: 463-469
• 39 Kiyosue A, Hirata Y, Ando J et al. Relationship between renal dysfunction and severity of coronary artery disease in Japanese patients. Circ J 2010; 74: 786-791
• 40 Cao XF, Yan LQ, Han LX et al. Association of mild to moderate kidney dysfunction with coronary artery calcification in patients with suspected coronary artery disease. Cardiology 2011; 120: 211-216
• 41 Cooper RG. Effect of tobacco smoking on renal function. Indian J Med Res 2006; 124: 261-268