Estimated glomerular filtration rate (eGFR) based on cystatin rather than creatinine enables more accurate determination of cardiovascular risk in patients with mild chronic kidney disease (CKD, investigators report.

Among 428,402 adults from the 2006-2010 UK Biobank, 5205 cardiovascular events occurred in the group aged 65-73 years and 9328 cardiovascular events in the group younger than 65 years. Cardiovascular events included fatal or nonfatal myocardial infarction, stroke, and cardiovascular death. All-cause mortality occurred in 9335 adults in the older group and 14,776 adults in the younger group.

The 10-year probabilities of cardiovascular events and mortality were low in both age groups when cystatin C-based eGFR was 60 mL/min/1.73 m2 or higher. When cystatin C-based eGFR was less than 60 mL/min/1.73 m2, however, the 10-year risks were nearly doubled in the older group and more than doubled in the younger group, Jennifer S. Lees, PhD, of the School of Cardiovascular and Metabolic Health, University of Glasgow in the UK, and colleagues reported in JAMA Network Open.

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Compared with creatinine-based eGFR (eGFRcr), cystatin C-based eGFR (eGFRcys) better discriminated cardiovascular events and mortality risks, the investigators reported. Using a 7.5% 10-year risk threshold for cardiovascular disease, cystatin C-based eGFR improved case Net Reclassification Index by 0.7% in both the older and younger group, whereas creatinine-based eGFR did not.

“In the absence of significant albuminuria, eGFRcys was both more sensitive and specific for high-risk CKD, better stratified individuals as having lower or higher risk of CVD and mortality compared with eGFRcr, and performed better than other accepted risk factors for CVD in the general population,” Dr Lees’ team wrote.

These findings have important implications for CKD guideline development.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Lees JS, Rutherford E, Stevens KI, et al. Assessment of cystatin C level for risk stratification in adults with chronic kidney disease. JAMA Netw Open. Published online October 25, 2022. doi:10.1001/jamanetworkopen.2022.38300