Key result
Confirmed CKD linked to ~5.1-fold higher odds of peripheral arterial disease.
Why the study?
Serum cystatin C is reported to be superior to serum creatinine as a risk factor for atherosclerotic disease, but these associations may vary across vascular beds.
Does kidney function estimated using serum cystatin C improve the identification of peripheral arterial disease compared to serum creatinine in adults aged 40+?
Cross-Sectional (n=3,089)
Yes
Does kidney function estimated using serum cystatin C improve the identification of peripheral arterial disease compared to serum creatinine in adults aged 40+?
Cystatin C is a more potent marker of lower extremity peripheral arterial disease than serum creatinine and may have clinical utility when combined with serum creatinine in evaluating individuals for PAD.
Confirmed CKD by dual markers associated with PAD; leaves open whether cystatin C-based eGFR improves identification beyond creatinine in observational data.
AIMS: Serum cystatin C, a novel marker of kidney function, is reported to be superior to serum creatinine as a risk factor for atherosclerotic disease, but associations may vary across vascular beds. METHODS AND RESULTS: A cross-sectional study of chronic kidney disease (CKD) and peripheral arterial disease (PAD) in 3089 adult participants aged 40+ from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). Kidney function, assessed by estimated glomerular filtration rate (eGFR), was determined from serum creatinine and cystatin C using established equations. Peripheral arterial disease defined by an ankle brachial index <0.90. Glomerular filtration rate estimated using cystatin C was more strongly associated with PAD compared with eGFR using serum creatinine before and after multivariable adjustment. Further, after adjustment for cystatin C, kidney function based on serum creatinine was no longer significantly associated with PAD. However, cystatin C remained significantly associated with PAD even after adjustment for GFR estimated by serum creatinine. Compared with optimal kidney function (eGFR(serum creatinine) >or=60, eGFR(cystatin C) >90), the odds ratio for PAD was 3.11 (95% confidence interval 1.26-7.64) for preclinical CKD (eGFR(serum creatinine) >or=60, eGFR(cystatin C) <76.7) and 5.07 (3.01-8.52) for 'confirmed' CKD (eGFR(serum creatinine) <60, eGFR(cystatin C) <60). CONCLUSION: Chronic kidney disease was strongly and independently associated with PAD. Cystatin C was a more potent marker of lower extremity PAD when compared with the serum creatinine equation currently used in clinical practice. Our results suggest that cystatin C may have clinical utility when combined with serum creatinine in evaluation of individuals who may have PAD.
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Selvin et al. (2009) conducted a cross-sectional in Chronic kidney disease and peripheral arterial disease (n=3,089). Confirmed chronic kidney disease (eGFR creatinine <60 and eGFR cystatin C <60) vs. Optimal kidney function (eGFR creatinine ≥60 and eGFR cystatin C >90) was evaluated on Peripheral arterial disease defined by an ankle brachial index <0.90 (OR 5.07, 95% CI 3.01-8.52). Confirmed CKD (eGFR <60 by both creatinine and cystatin C) vs optimal kidney function was strongly associated with peripheral arterial disease (OR 5.07; 95% CI 3.01-8.52).
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