Yonsei Med J.  2017 Mar;58(2):380-387. 10.3349/ymj.2017.58.2.380.

Cystatin C is Better than Serum Creatinine for Estimating Glomerular Filtration Rate to Detect Osteopenia in Chronic Kidney Disease Patients

• Kwon YE
• Lee MJ
• Park KS
• Han SH
• Yoo TH
• Oh KH
• Lee J
• Lee KB
• Chung W
• Kim YH
• Ahn C
• Choi KH

• KMID: 2427127
• DOI: http://doi.org/10.3349/ymj.2017.58.2.380

Abstract

PURPOSE
Recent studies have reported that loss of bone mass is associated with renal function decline and increased fracture risks in chronic kidney disease (CKD) patients. The aim of this study was to investigate the best estimated glomerular filtration rate (eGFR) equation to detect osteopenia in CKD patients.
MATERIALS AND METHODS
This was a cross-sectional study, and 780 patients aged 50 years or above were classified into normal bone mass or osteopenia groups according to the -1.0 of T-scores at total hip and femur neck. Comparisons of area under the receiver operating characteristic (ROC) curves (AUC) were performed to investigate significant differences among three eGFR formulas: Modification of Diet in Renal Disease, CKD-Epidemiology Collaboration (EPI) creatinine, and CKD-EPI cystatin C (CKD-EPI-Cys).
RESULTS
The mean age was 61 years old and the proportion of females was 37.3%. The total hip osteopenia group showed lower CKD-EPI-Cys eGFR levels (osteopenia group, 33.3±19.0 mL/min/1.73 m²; normal group, 48.1±26.2 mL/min/1.73 m², p<0.001). In multiple logistic regression analysis, CKD-EPI-Cys eGFR was independently associated with osteopenia at the total hip (per 1 mL/min/1.73 m² increase, odds ratio 0.98, 95% confidence interval 0.97-0.99, p=0.004) after adjusting for confounding variables. ROC curve analyses indicated that CKD-EPI-Cys shows the largest AUC for osteopenia at the total hip (AUC=0.678, all p<0.01) and the femur neck (AUC=0.665, all p<0.05).
CONCLUSION
Decreased renal function assessed by CKD-EPI-Cys equation correlates with osteopenia better than creatinine-based methods in CKD patients, and the CKD-EPI-Cys formula might be a useful tool to assess skeletal-related event risks.

Keyword

Renal insufficiency; chronic; bone diseases; metabolic; glomerular filtration rate

MeSH Terms

Adult
Aged
Biomarkers/blood
Bone Diseases, Metabolic/blood/*diagnosis/physiopathology
Chronic Kidney Disease-Mineral and Bone Disorder/blood/*diagnosis/physiopathology
Creatinine/*blood
Cross-Sectional Studies
Cystatin C/*blood
Female
*Glomerular Filtration Rate
Humans
Male
Middle Aged
ROC Curve
Renal Insufficiency, Chronic/blood/*complications/physiopathology
Biomarkers
Cystatin C
Creatinine

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