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

 Young Eun Kwon  ;  Mi Jung Lee  ;  Kyoung Sook Park  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Kook-Hwan Oh  ;  Joongyub Lee  ;  Kyu Beck Lee  ;  Wookyung Chung  ;  Yeong-Hoon Kim  ;  Curie Ahn  ;  Kyu Hun Choi 
 YONSEI MEDICAL JOURNAL, Vol.58(2) : 380-387, 2017 
Journal Title
Issue Date
Adult ; Aged ; Biomarkers/blood ; Bone Diseases, Metabolic/blood ; Bone Diseases, Metabolic/diagnosis* ; Bone Diseases, Metabolic/physiopathology ; Chronic Kidney Disease-Mineral and Bone Disorder/blood ; Chronic Kidney Disease-Mineral and Bone Disorder/diagnosis* ; Chronic Kidney Disease-Mineral and Bone Disorder/physiopathology ; Creatinine/blood* ; Cross-Sectional Studies ; Cystatin C/blood* ; Female ; Glomerular Filtration Rate* ; Humans ; Male ; Middle Aged ; ROC Curve ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/complications* ; Renal Insufficiency, Chronic/physiopathology
Renal insufficiency ; bone diseases ; chronic ; glomerular filtration rate ; metabolic
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Young Eun(권영은)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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