Michael P Delaney1, Paul E Stevens1, Helen J Witham2, Caroline Judge1, Gillian L Eaglestone1, Joanne L Carter2, Paul Bassett3, Edmund J Lamb4. 1. Kent Kidney Care Centre and Clinical Biochemistry, Kent and Canterbury Hospital, Canterbury, Kent, UK. 2. East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK. 3. Statsconsultancy Ltd., Amersham, Bucks, UK. 4. East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK elamb@nhs.net.
Abstract
UNLABELLED: ♦ BACKGROUND: Small solute clearance, especially that derived from residual renal function (RRF), is an independent risk factor for death in peritoneal dialysis (PD) patients. Assessment of solute clearance is time-consuming and prone to multiple errors. Cystatin C is a small protein which has been used as a glomerular filtration rate (GFR) marker. We investigated whether serum cystatin C concentrations are related to mortality in patients receiving PD. ♦ METHODS: New and prevalent PD patients (n = 235) underwent assessment of Kt/Vurea, RRF, weekly creatinine clearance (CCr), normalized protein catabolic rate (nPCR) and a peritoneal equilibration test (PET) at intervals. Blood was collected simultaneously for cystatin C measurement. Patients were followed for a median of 1,429 days (range 12 to 2,964 days) until death or study closure. Cause of death was recorded where given. Cox regression was performed to determine whether cystatin C had prognostic value either independently or with adjustment for other factors (age, sex, dialysis modality, diabetic status, cardiovascular comorbidity, Kt/V, CCr, RRF, nPCR or 4 h dialysate to plasma creatinine ratio (4 h D/Pcr) during the PET). The primary outcomes were all-cause mortality and treatment failure. ♦ RESULTS: There were 93 deaths. Increasing age and 4 h D/Pcr ratio, decreased RRF and presence of diabetes were significantly [p < 0.05] negatively associated with survival and treatment failure. Serum cystatin C was not related to either outcome. ♦ CONCLUSIONS: Serum cystatin C concentration does not predict mortality or treatment failure in patients receiving PD.
UNLABELLED: ♦ BACKGROUND: Small solute clearance, especially that derived from residual renal function (RRF), is an independent risk factor for death in peritoneal dialysis (PD) patients. Assessment of solute clearance is time-consuming and prone to multiple errors. Cystatin C is a small protein which has been used as a glomerular filtration rate (GFR) marker. We investigated whether serum cystatin C concentrations are related to mortality in patients receiving PD. ♦ METHODS: New and prevalent PDpatients (n = 235) underwent assessment of Kt/Vurea, RRF, weekly creatinine clearance (CCr), normalized protein catabolic rate (nPCR) and a peritoneal equilibration test (PET) at intervals. Blood was collected simultaneously for cystatin C measurement. Patients were followed for a median of 1,429 days (range 12 to 2,964 days) until death or study closure. Cause of death was recorded where given. Cox regression was performed to determine whether cystatin C had prognostic value either independently or with adjustment for other factors (age, sex, dialysis modality, diabetic status, cardiovascular comorbidity, Kt/V, CCr, RRF, nPCR or 4 h dialysate to plasma creatinine ratio (4 h D/Pcr) during the PET). The primary outcomes were all-cause mortality and treatment failure. ♦ RESULTS: There were 93 deaths. Increasing age and 4 h D/Pcr ratio, decreased RRF and presence of diabetes were significantly [p < 0.05] negatively associated with survival and treatment failure. Serum cystatin C was not related to either outcome. ♦ CONCLUSIONS: Serum cystatin C concentration does not predict mortality or treatment failure in patients receiving PD.
Authors: Fabian Termorshuizen; Johanna C Korevaar; Friedo W Dekker; Jeannette G van Manen; Elisabeth W Boeschoten; Raymond T Krediet Journal: Am J Kidney Dis Date: 2003-06 Impact factor: 8.860
Authors: Michael P Delaney; Paul E Stevens; Mohammed Al Hasani; Helen J Stowe; Caroline Judge; Edmund J Lamb Journal: Am J Kidney Dis Date: 2008-02 Impact factor: 8.860