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Abstract: PO1110

Comparison of Mortality Risk Across Deciles of Cystatin C and Creatinine Among US Veterans

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wenziger, Cachet, VA Long Beach Healthcare System, Long Beach, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
  • Sy, John, VA Long Beach Healthcare System, Long Beach, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Hanna, Ramy Magdy, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Crowley, Susan T., Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

While both creatinine and Cystatin C (CysC) are markers of renal function, a low serum creatinine level can be related to less muscle mass and hence associated with worse outcomes. Prior studies among elderly persons found that higher serum CysC and creatinine levels were predictors of mortality. However, this relationship has not been examined in contemporary cohorts of US veterans. We sought to examine the relationship of creatinine and CysC with mortality risk in US veterans.

Methods

We examined a historical cohort consisting of 7,849 Veterans with baseline CysC and creatinine data between 10/01/2004-09/30/2015. Veterans were divided into deciles of serum creatinine and CysC levels separately. We examined the association of deciles with all-cause mortality using Cox proportional hazards regression adjusted for demographics, comorbidities, and other lab variables using decile 5 as the reference.

Results

The mean age in the cohort was 69±12, 4% were female, 77% were white, 15% were African American. The median (IQR (interquartile range)) for CysC was 1.28 (0.99,1.71) mg/L, for creatinine 1.24 (0.92,1.68) mg/dl. There were 1872/7849(24%) deaths during follow-up(follow-up time median(IQR): 794(461,1244) days). Patients with the highest decile of either CysC or creatinine had the highest mortality risk compared to the reference. Conversely, risk of mortality was incrementally lower for each decile below the reference for CysC while lower creatinine deciles were associated with a null to higher risk of death [figure].

Conclusion

Among US veterans, there is a linear relationship between CysC and mortality risk while the relationship between creatinine and mortality risk is U-shaped. These clinical results indicate that CysC may be a better marker of risk for adverse outcomes than creatinine, as previously shown in epidemiological studies.

Cox proportional hazards model showing the relationship between deciles of creatinine and cystatin C with all-cause mortality (Reference:5th decile). Model adjustments include demographics and comorbidities and lab variables.