Cystatin C and Cardiac Measures in Children and Adolescents With CKD

被引:15
作者
Brady, Tammy M. [1 ]
Townsend, Kelly [2 ]
Schneider, Michael F. [2 ]
Cox, Christopher [2 ]
Kimball, Thomas [3 ]
Madueme, Peace [3 ]
Warady, Bradley [4 ]
Furth, Susan [5 ]
Mitsnefes, Mark [6 ]
机构
[1] Johns Hopkins Univ, Div Pediat Nephrol, Sch Med, Baltimore, MD USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
[3] Cincinnati Childrens Hosp Med Ctr, Inst Heart, Cincinnati, OH 45229 USA
[4] Childrens Mercy Hosp, Div Pediat Nephrol, Kansas City, MO 64108 USA
[5] Childrens Hosp Philadelphia, Div Nephrol, Philadelphia, PA 19104 USA
[6] Cincinnati Childrens Hosp Med Ctr, Div Nephrol & Hypertens, Cincinnati, OH 45229 USA
基金
美国国家卫生研究院;
关键词
Biomarker; cardiovascular disease (CVD); left ventricular hypertrophy (LVH); left ventricular mass (LVM); pediatrics; children; adolescents; systolic function; cystatin C; chronic kidney disease (CKD); renal function; echocardiograph; cardiac structure; cardiac function; VENTRICULAR DIASTOLIC FUNCTION; GLOMERULAR-FILTRATION-RATE; CHRONIC KIDNEY-DISEASE; CARDIOVASCULAR-DISEASE; RISK-FACTOR; ASSOCIATION; MORTALITY; HEART; SERUM; RECOMMENDATIONS;
D O I
10.1053/j.ajkd.2016.08.036
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Cardiovascular disease (CVD) is highly prevalent among children with chronic kidney disease (CKD). Cystatin C is an established marker of kidney function and an emerging biomarker for CVD events. We quantified the relationship between cystatin C level and cardiac structure and function over time among children with CKD and assessed whether cystatin C level and diastolic function retained an association after accounting for kidney function. Study Design: Prospective cohort study. Setting & Participants: 678 children and adolescents with mild to moderate CKD enrolled in the CKD in Children (CKiD) Study with 1,228 echocardiographically obtained cardiac structure and function measurements. Predictor: Serum cystatin C (mg/L) measured annually. Outcomes: Cardiac structure (left ventricular mass index [g/m(2.7)]) and cardiac function (shortening fraction; E/A, E'/A', E/E' ratios) measured every other year. Measurements: Demographics and anthropometrics, measured glomerular filtration rate (mGFR), heart rate, blood pressure, hemoglobin z score, serum albumin level, and calcium-phosphorus product. Results: Independent of time, each 1-mg/L increase in cystatin C level was independently associated with a concurrent 7.7% (95% CI, 5.3%-10.0%) increase in left ventricular mass index, a 24.7% (95% CI, -7.0% to -2.4%) change in E/A ratio, a -6.6% (95% CI, -9.0% to -4.2%) change in E'/A' ratio, and a 2.5% (95% CI, 0.3%-4.7%) increase in E/E' ratio. mGFR was also independently associated with E'/A' ratio. When cystatin C level and mGFR were included in the same model, cystatin C level remained independently associated with E'/A' ratio, whereas mGFR was not. Limitations: 24% of the cohort was missing data for outcomes of interest or measurements; study population includes only children and adolescents with mild to moderate CKD. Conclusions: In this study of children and adolescents with mild to moderate CKD, cystatin C level was independently associated with cardiac structure and diastolic function. Cystatin C level remained able to predict diastolic function decline via E'/A' ratio even after adjusting for mGFR, suggesting that cystatin C level may have an independent role in CVD risk stratification among children and adolescents with CKD. (C) 2016 by the National Kidney Foundation, Inc.
引用
收藏
页码:247 / 256
页数:10
相关论文
共 28 条
[1]   Cystatin C: An Emerging Biomarker in Cardiovascular Disease [J].
Angelidis, Christos ;
Deftereos, Spyridon ;
Giannopoulos, Georgios ;
Anatoliotakis, Nikolaos ;
Bouras, Georgios ;
Hatzis, Georgios ;
Panagopoulou, Vasiliki ;
Pyrgakis, Vlasios ;
Cleman, Michael W. .
CURRENT TOPICS IN MEDICINAL CHEMISTRY, 2013, 13 (02) :164-179
[2]   Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study) [J].
Cai, Qi-Zhe ;
Lu, Xiu-Zhang ;
Lu, Ye ;
Wang, Angela Yee-Moon .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2014, 25 (07) :1599-1608
[3]  
Collins Allan J, 2014, Am J Kidney Dis, V63, pA7, DOI 10.1053/j.ajkd.2013.11.001
[4]   Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency [J].
Culleton, BF ;
Larson, MG ;
Wilson, PWF ;
Evans, JC ;
Parfrey, PS ;
Levy, D .
KIDNEY INTERNATIONAL, 1999, 56 (06) :2214-2219
[5]   ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-VENTRICULAR HYPERTROPHY - COMPARISON TO NECROPSY FINDINGS [J].
DEVEREUX, RB ;
ALONSO, DR ;
LUTAS, EM ;
GOTTLIEB, GJ ;
CAMPO, E ;
SACHS, I ;
REICHEK, N .
AMERICAN JOURNAL OF CARDIOLOGY, 1986, 57 (06) :450-458
[6]   Moderate renal insufficiency and the risk of cardiovascular mortality: Results from the NHANES I [J].
Garg, AX ;
Clark, WF ;
Haynes, RB ;
House, AA .
KIDNEY INTERNATIONAL, 2002, 61 (04) :1486-1494
[7]   Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis:: a cross-sectional study [J].
Ketteler, M ;
Bongartz, P ;
Westenfeld, R ;
Wildberger, JE ;
Mahnken, AH ;
Böhm, R ;
Metzger, T ;
Wanner, C ;
Jahnen-Dechent, W ;
Floege, J .
LANCET, 2003, 361 (9360) :827-833
[8]   Age-Specific Reference Intervals for Indexed Left Ventricular Mass in Children [J].
Khoury, Philip R. ;
Mitsnefes, Mark ;
Daniels, Stephen R. ;
Kimball, Thomas R. .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2009, 22 (06) :709-714
[9]   Plasma concentrations of cystatin C in patients with coronary heart disease and risk for secondary cardiovascular events: More than simply a marker of glomerular filtration rate [J].
Koenig, W ;
Twardella, D ;
Brenner, H ;
Rothenbacher, D .
CLINICAL CHEMISTRY, 2005, 51 (02) :321-327
[10]   Recommendations for chamber quantification: A report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology [J].
Lang, RM ;
Bierig, M ;
Devereux, RB ;
Flachskampf, FA ;
Foster, E ;
Pellikka, PA ;
Picard, MH ;
Roman, MJ ;
Seward, J ;
Shanewise, JS ;
Solomon, SD ;
Spencer, KT ;
Sutton, MS ;
Stewart, WJ .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2005, 18 (12) :1440-1463