Discordance in Creatinine- and Cystatin C–Based eGFR and Clinical Outcomes

作者：Michelle M. Estrella, Shoshana H. Ballew, Yingying Sang, Morgan E. Grams, Josef Coresh, Aditya Surapaneni, Natalia Alencar de Pinho, Johan Ärnlöv, Hermann Brenner, Juan Jesús Carrero, Teresa K. Chen, Debbie L. Cohen, Mary Cushman, Ron T. Gansevoort, Shih‐Jen Hwang, Lesley A. Inker, Joachim H. Ix, Keiko Kabasawa, Tsuneo Konta, Jennifer S. Lees, Kevan R. Polkinghorne, Michael G. Shlipak, Robin W.M. Vernooij, David C. Wheeler, Ashok K. Yadav, Andrew S. Levey, Kai‐Uwe Eckardt, Teresa K. Chen, Yingying Sang, Morgan E. Grams, Josef Coresh, Steven J. Chadban, Kevan Polkinghorne, Nisha Bansal, Joachim H. Ix, Michael G. Shlipak, Marie-Hélène Metzger, Bénédicte Stengel, Martin Landray, John Townend, Jonathan Emberson, Chi‐yuan Hsu, Wei Yang, Amanda Anderson, Hermann Brenner, Dietrich Rothenbacher, Ben Schöttker, Hannah Stocker, Daniel Levy, Martin Larson, Anna Köttgen, Peggy Sekula, Ulla T. Schultheiß, Markus P. Schneider, Vivek Kumar, Manisha Sahay, Narayan Prasad, Robin W.M. Vernooij, Andrew S. Levey, Lesley A. Inker, Mark J. Sarnak, Orlando M. Gutiérrez, Mary Cushman, Stephan J. L. Bakker, Lyanne M. Kieneker, Marco van Londen, Katharine L. Cheung, Titilayo O. Ilori, Edouard L. Fu, Anne‐Laure Faucon, Aurora Caldinelli, Antoine Créon, Tsuneo Konta, Kazunobu Ichikawa, Satoru Nagase, Masafumi Watanabe, Jennifer S. Lees, Patrick B. Mark, Anders Larsson, Vilmantas Giedraitis, Keiko Kabasawa, Yumi Ito, Junta Tanaka, Ichiei Narita, Michelle M. Estrella, Shoshana H. Ballew, Juan Jesús Carrero, Ron T. Gansevoort, Kunihiro Matsushita, Dorothea Nitsch, Angela Yee‐Moon Wang, Carina Flaherty, Aditya Surapaneni · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.17578 · 被引用次数：16 · 研究领域：Chronic Kidney Disease and Diabetes、Blood Pressure and Hypertension Studies、Dialysis and Renal Disease Management

Importance: Estimated glomerular filtration rates (eGFRs) can differ according to whether creatinine or cystatin C is used for the eGFR calculation, but the prevalence and importance of these differences remain unclear. Objectives: To evaluate the prevalence of a discordance between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr), identify characteristics associated with greater discordance, and evaluate associations of discordance with adverse outcomes. Data Sources: Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC). Study Selection: Participants with concurrent cystatin C and creatinine measurements and clinical outcome measurement. Data Extraction and Synthesis: Between April 2024 and August 2025, data were synthesized using individual-level meta-analysis. Main Outcomes and Measures: The primary independent measurement was a large negative eGFR difference (eGFRdiff), defined as an eGFRcys that was at least 30% lower than eGFRcr. Secondary (dependent) outcomes included all-cause and cardiovascular mortality, atherosclerotic cardiovascular disease, heart failure, and kidney failure with replacement therapy. Results: A total of 821 327 individuals from 23 outpatient cohorts (mean [SD] age, 59 [12] years; 48% female; 13.5% with diabetes; 40% with hypertension) and 39 639 individuals from 2 inpatient cohorts (mean [SD] age, 67 [16] years; 31% female; 30% with diabetes; 72% with hypertension) were included. Among outpatient participants,...