Kidney Week

Abstract: FR-PO342

The Difference between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate and Risk of Peripheral Artery Disease

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• He, Daijun, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China

Daijun He, MD, PhD

• Li, Chenglong, Peking University Health Science Center, Beijing, Beijing, China

Chenglong Li, PhD

• Gao, Bixia, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China

Bixia Gao

• Yang, Chao, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China

Chao Yang, MS, MPH

• Wang, Jinwei, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China

Jinwei Wang, PhD

• Zhao, Ming-Hui, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China

Ming-Hui Zhao, MD, PhD

• Zhang, Luxia, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China

Luxia Zhang, MD, MPH

Background

The difference between cystatin C-based and creatinine-based estimated glomerular filtration rate (eGFRdiff) has been suggested to reflect factors that are associated with cardiovascular and microvascular risk, independent of kidney function. However, the association between eGFRdiff and risk of peripheral artery disease (PAD) has not been extensively evaluated.

Methods

This prospective cohort study included 466,245 participants with concurrent measured serum creatinine and cystatin C and free of PAD at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based eGFR. Incidence of PAD was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with PAD. The relative importance of eGFRdiff in predicting PAD was evaluated. We also calculated the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to examine the additive value of eGFRdiff in predicting PAD.

Results

During a median follow-up of 13.8 years, PAD developed in 7,210 participants. Each standard deviation increment of eGFRabdiff was associated with a 33% lower risk of PAD. For each 10% increment in eGFRrediff, the hazard ratio (95% confidence interval) was 0.78 (0.77, 0.80) for PAD. eGFRrediff and eGFRabdiff ranked 6th and 11th in the relative importance of PAD prediction, surpassing eGFRcr and some traditional risk factors. Adding eGFRabdiff or eGFRrediff into the established model could improve the performance of PAD prediction (ΔAUC 0.013, NRI 0.325, IDI 0.003 for adding eGFRabdiff; ΔAUC 0.012, NRI 0.287, IDI 0.003 for adding eGFRrediff).

Conclusion

eGFRdiff was associated with risk of incident PAD and had additional value in predicting PAD. These findings may have implications for the management of patients at risk of incident PAD.

Restricted cubic spline models assessing exposure-response associations between eGFRdiff with PAD.