{"title":"基于胱抑素和肌酸酐的估计肾小球滤过率个体内差异与对比度相关急性肾损伤的关系","authors":"Li-Wei Zhang, Man-Qing Luo, Ji-Lang Zeng, Zhe-Bin You, Li-Chuan Chen, Jun-Han Chen, Kai-Yang Lin, Yan-Song Guo","doi":"10.2147/cia.s447042","DOIUrl":null,"url":null,"abstract":"<strong>Purpose:</strong> The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI).<br/><strong>Patients and Methods:</strong> From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m<sup>2</sup>.<br/><strong>Results:</strong> Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between − 15 and 15 mL/min/1.73 m<sup>2</sup>. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (− 15 to 15 mL/min/1.73 m<sup>2</sup>), the negative-eGFRdiff group (less than − 15 mL/min/1.73 m<sup>2</sup>) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57– 4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19– 3.95, <em>P</em> < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19– 4.63, <em>P</em> < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr.<br/><strong>Conclusion:</strong> There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.<br/><br/><strong>Keywords:</strong> estimated glomerular filtration rate, contrast-associated acute kidney injury, cystatin C, percutaneous coronary intervention<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"41 5 1","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Association of Intraindividual Difference Between Cystatin- and Creatinine-Based Estimated GFR and Contrast-Associated Acute Kidney Injury\",\"authors\":\"Li-Wei Zhang, Man-Qing Luo, Ji-Lang Zeng, Zhe-Bin You, Li-Chuan Chen, Jun-Han Chen, Kai-Yang Lin, Yan-Song Guo\",\"doi\":\"10.2147/cia.s447042\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<strong>Purpose:</strong> The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI).<br/><strong>Patients and Methods:</strong> From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m<sup>2</sup>.<br/><strong>Results:</strong> Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between − 15 and 15 mL/min/1.73 m<sup>2</sup>. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (− 15 to 15 mL/min/1.73 m<sup>2</sup>), the negative-eGFRdiff group (less than − 15 mL/min/1.73 m<sup>2</sup>) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57– 4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19– 3.95, <em>P</em> < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19– 4.63, <em>P</em> < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr.<br/><strong>Conclusion:</strong> There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.<br/><br/><strong>Keywords:</strong> estimated glomerular filtration rate, contrast-associated acute kidney injury, cystatin C, percutaneous coronary intervention<br/>\",\"PeriodicalId\":10417,\"journal\":{\"name\":\"Clinical Interventions in Aging\",\"volume\":\"41 5 1\",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-03-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Interventions in Aging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/cia.s447042\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Interventions in Aging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/cia.s447042","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
The Association of Intraindividual Difference Between Cystatin- and Creatinine-Based Estimated GFR and Contrast-Associated Acute Kidney Injury
Purpose: The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI). Patients and Methods: From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m2. Results: Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between − 15 and 15 mL/min/1.73 m2. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (− 15 to 15 mL/min/1.73 m2), the negative-eGFRdiff group (less than − 15 mL/min/1.73 m2) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57– 4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19– 3.95, P < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19– 4.63, P < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr. Conclusion: There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.
期刊介绍：
Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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