Diabetes & Metabolism Journal

Original Articles

Cardiovascular Risk/Epidemiology
The Ratio of Estimated Glomerular Filtration Rate Based on Cystatin C and Creatinine Reflecting Cardiovascular Risk in Diabetic Patients: Ah Reum Khang, Min Jin Lee, Dongwon Yi, Yang Ho Kang; Diabetes Metab J. 2023;47(3):415-425. Published online March 6, 2023; DOI: https://doi.org/10.4093/dmj.2022.0177

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Background
The ratio of estimated glomerular filtration rate (eGFR) based on cystatin C and creatinine (eGFR_{cystatin C}/eGF_Rcreatinine ratio) is related to accumulating atherosclerosis-promoting proteins and increased mortality in several cohorts.
Methods
We assessed whether the eGFR_{cystatin C}/eGFR_creatinine ratio is a predictor of arterial stiffness and sub-clinical atherosclerosis in type 2 diabetes mellitus (T2DM) patients, who were followed up during 2008 to 2016. GFR was estimated using an equation based on cystatin C and creatinine.
Results
A total of 860 patients were stratified according to their eGFR_{cystatin C}/eGF_Rcreatinine ratio (i.e., <0.9, 0.9–1.1 [a reference group], and >1.1). Intima-media thickness was comparable among the groups; however, presence of carotid plaque was frequent in the <0.9 group (<0.9 group, 38.3%; 0.9–1.1 group, 21.6% vs. >1.1 group, 17.2%, P<0.001). Brachial-ankle pulse wave velocity (baPWV) was faster in the <0.9 group (<0.9 group, 1,656.3±333.0 cm/sec; 0.9–1.1 group, 1,550.5±294.8 cm/sec vs. >1.1 group, 1,494.0±252.2 cm/sec, P<0.001). On comparing the <0.9 group with the 0.9–1.1 group, the multivariate-adjusted odds ratios of prevalence of high baPWV and carotid plaque were 2.54 (P=0.007) and 1.95 (P=0.042), respectively. Cox regression analysis demonstrated near or over 3-fold higher risks of the prevalence of high baPWV and carotid plaque in the <0.9 group without chronic kidney disease (CKD).
Conclusion
We concluded that eGFR_{cystatin C}/eGFR_creatinine ratio <0.9 was related to an increased risk of high baPWV and carotid plaque in T2DM patients, especially, those without CKD. Careful monitoring of cardiovascular disease is needed for T2DM patients with low eGFR_{cystatin C}/eGFR_creatinine ratio.

Citations

Citations to this article as recorded by

Intraindividual difference in estimated GFR by creatinine and cystatin C, cognitive trajectories and motoric cognitive risk syndrome
Jinqi Wang, Yueruijing Liu, Rui Jin, Xiaoyu Zhao, Zhiyuan Wu, Ze Han, Zongkai Xu, Xiuhua Guo, Lixin Tao
Nephrology Dialysis Transplantation.2024; 39(5): 860. CrossRef
Research Progress of Creatinine, Cystatin C, and Their Ratio in Renal Diseases
广智杨
Advances in Clinical Medicine.2024; 14(04): 976. CrossRef
Muscle mass, creatinine, cystatin C and selective glomerular hypofiltration syndromes
Linnea Malmgren, Anders Grubb
Clinical Kidney Journal.2023; 16(8): 1206. CrossRef
Investigating kidney function changes in young adults with COVID-19: Serum creatinine level, glomerular filtration rate, and biochemical profile analysis
Nikita Matyushin, Dmitriy Ermakov, Inna Vasileva, Roza Vakolyuk, Anastasiya Spaska
Electronic Journal of General Medicine.2023; 20(6): em547. CrossRef

Metabolic Risk/Epidemiology
Normalized Creatinine-to-Cystatin C Ratio and Risk of Diabetes in Middle-Aged and Older Adults: The China Health and Retirement Longitudinal Study: Shanhu Qiu, Xue Cai, Bo Xie, Yang Yuan, Zilin Sun, Tongzhi Wu; Diabetes Metab J. 2022;46(3):476-485. Published online March 7, 2022; DOI: https://doi.org/10.4093/dmj.2021.0074

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Background
Creatinine-to-cystatin C ratio is recently suggested to be a surrogate marker for sarcopenia. However, little is known about its association with diabetes. This study aimed to fill in this gap based on a large-scale prospective cohort.
Methods
A population-based representative sample of 5,055 participants aged ≥45 years from the China Health and Retirement Longitudinal Study was enrolled between 2011 and 2012 and followed at least once during the subsequent surveys at 2013, 2015, or 2018. Creatinine-to-cystatin C ratio was calculated and normalized by body weight. Incident diabetes was ascertained by plasma glucose, glycosylated hemoglobin, self-reported history, or use of anti-diabetic drugs. Logistic regression analysis and mediation analysis were employed.
Results
During follow-up, 634 participants developed diabetes. The risk of diabetes was gradually and significantly decreased with increased normalized creatinine–cystatin C ratio. The multivariable-adjusted odds ratio for diabetes was 0.91 (95% confidence interval, 0.83 to 0.99) per 1 standard deviation higher of normalized creatinine-to-cystatin C ratio, and this relationship remained significant after controlling for muscle strength. The risk reduction in diabetes was significantly larger in participants with normal-weight and high normalized creatinine-to-cystatin C ratio compared with those with overweight/obesity and high normalized creatinine-to-cystatin C ratio (P_interaction=0.01). Insulin resistance and inflammation appeared to be key mediators accounting for the observed relationship between normalized creatinine-to-cystatin C ratio and risk of diabetes, with their mediating effect being 93.1% and 22.0%, respectively.
Conclusion
High normalized creatinine-to-cystatin C ratio is associated with reduced risk of diabetes in middle-aged and older adults.

Citations

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Muscle Quality in Relation to Prediabetes Phenotypes: A Population-Based Study With Mediation Analysis
Shanhu Qiu, Xue Cai, Xiaoying Zhou, Jinshui Xu, Zilin Sun, Haijian Guo, Tongzhi Wu
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): e1151. CrossRef
Sex‐specific associations between skeletal muscle mass and incident diabetes: A population‐based cohort study
Dan Liu, Nan Li, Yiling Zhou, Miye Wang, Peige Song, Changzheng Yuan, Qingyang Shi, Hui Chen, Kaixin Zhou, Huan Wang, Tao Li, Xiong‐Fei Pan, Haoming Tian, Sheyu Li
Diabetes, Obesity and Metabolism.2024; 26(3): 820. CrossRef
Diabetes Mellitus Should Be Considered While Analysing Sarcopenia-Related Biomarkers
Justyna Rentflejsz, Zyta Beata Wojszel
Journal of Clinical Medicine.2024; 13(4): 1107. CrossRef
Associations of muscle mass and strength with new-onset diabetes among middle-aged and older adults: evidence from the China health and retirement longitudinal study (CHARLS)
Yun-Yun He, Mei-Ling Jin, Xiang-Yang Fang, Xiao-Juan Wang
Acta Diabetologica.2024;[Epub] CrossRef
The serum creatinine to cystatin C to waist circumference ratios predicts risk for type 2 diabetes: A Chinese cohort study
Yinfei Chen, Weiheng Wen, Zhiliang Mai, Ming Wang, Hong Chen, Jia Sun
Journal of Diabetes.2023; 15(10): 808. CrossRef
Associations of sarcopenia with peak expiratory flow among community-dwelling elderly population: based on the China Health and Retirement Longitudinal Study (CHARLS)
Yun-Yun He, Mei-Ling Jin, Jing Chang, Xiao-Juan Wang
European Geriatric Medicine.2023; 15(1): 95. CrossRef
Additive impact of diabetes and sarcopenia on all-cause and cardiovascular mortality: A longitudinal nationwide population-based study
Eyun Song, Soon Young Hwang, Min Jeong Park, Ahreum Jang, Kyeong Jin Kim, Ji Hee Yu, Nam Hoon Kim, Hye Jin Yoo, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Kyung Mook Choi
Metabolism.2023; 148: 155678. CrossRef

Clinical Usefulness of Serum Cystatin C as a Marker of Renal Function: Kwang-Sook Woo, Jae-Lim Choi, Bo-Ram Kim, Ji-Eun Kim, Jin-Yeong Han; Diabetes Metab J. 2014;38(4):278-284. Published online August 20, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.4.278

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Background

Accurate renal function measurements are important in the diagnosis and treatment of kidney diseases. In contrast to creatinine, the production of serum cystatin C has been extensively reported to be unaffected by body muscle mass, age, gender, and nutritional status.

Methods

Our study included 37 samples from diabetic chronic kidney disease (CKD) patients for whom serum creatinine tests had been requested and 40 samples from a healthy populations in Dong-A University Hospital between May 2010 and June 2010. The assay precision (i.e., the coefficient of variation) and the reference range of the serum cystatin C test were evaluated. We compared the estimated glomerular filtration rates (GFRs) based on cystatin C with those based on creatinine. Moreover, we investigated the influences of age, gender, weight, and muscle mass on serum creatinine and serum cystatin C.

Results

There was a positive correlation between GFR based on creatinine and that based on cystatin C (r=0.79, P<0.0001) among the diabetic CKD patients. Serum creatinine and cystatin C were significantly correlated with body weight and muscle mass, but the strengths of these correlations were greater for serum creatinine. The precision study revealed excellent results for both the high and low controls. The 95% reference interval of cystatin C in the healthy population was 0.371 to 1.236 mg/L.

Conclusion

Based on these results, we conclude that, despite the strong correlation between serum creatinine and cystatin C, cystatin C is less affected by weight and muscle mass and might represent a better alternative for the assessment of renal function.

Citations

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Dyslipidemia and serum cystatin C levels as biomarker of diabetic nephropathy in patients with type 2 diabetes mellitus
Tadesse Asmamaw Dejenie, Endeshaw Chekol Abebe, Misganaw Asmamaw Mengstie, Mohammed Abdu Seid, Natnael Atnafu Gebeyehu, Getachew Asmare Adella, Gizchew Ambaw Kassie, Amanuel Yosef Gebrekidan, Molalegn Mesele Gesese, Kirubel Dagnaw Tegegne, Denekew Tenaw A
Frontiers in Endocrinology.2023;[Epub] CrossRef
Association between serum creatinine and type 2 diabetes in the Chinese population: a retrospective cohort study
Rugang Li, Min He, Qilin Yang, Zezhi Liang, Ying li, Ling Huang, Rong Wu, Jieping Huang
Scientific Reports.2023;[Epub] CrossRef
Significance of Diabetic Kidney Disease Biomarkers in Predicting Metabolic-Associated Fatty Liver Disease
Jaehyun Bae, Byung-Wan Lee
Biomedicines.2023; 11(7): 1928. CrossRef
Reconsideration of the current models of estimated kidney function‐based drug dose adjustment in older adults: The role of biological age
Radin Alikhani, Manjunath P. Pai
Clinical and Translational Science.2023; 16(11): 2095. CrossRef
The Level of Plasma Cystatin C in Patients with Chronic Kidney Disease
Tuan Nguyen Van, Linh Phan Ha, Diep Pham Thao, Minh Nguyen Thi Binh, Minh Hoang Thi, Thuan Huynh Quang, Lan Thi Phuong Dam
Nephro-Urology Monthly.2022;[Epub] CrossRef
Role of cystatin C in urogenital malignancy
Li Ding, Zijie Liu, Junqi Wang
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Jirarat Eiamcharoenying, Win Kulvichit, Nuttha Lumlertgul, Tawatchai Chaiwatanarat, Sadudee Peerapornratana, Nattachai Srisawat
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James Roland Markos, Karen S. Schaepe, Hilary R. Teaford, Andrew D. Rule, Kianoush B. Kashani, John C. Lieske, Erin F. Barreto, Pierre Delanaye
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Houston Wilson, Charles S Burks, Joshua E Reger, Jacob A Wenger, Kelly Tindall
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Evaluation of creatinine-based and cystatin C-based equations for estimation of glomerular filtration rate in type 1 diabetic patients
Caroline Pereira Domingueti, Rodrigo Bastos Fóscolo, Ana Cristina Simões e Silva, Luci Maria S. Dusse, Janice Sepúlveda Reis, Maria das Graças Carvalho, Ana Paula Fernandes, Karina Braga Gomes
Archives of Endocrinology and Metabolism.2016; 60(2): 108. CrossRef
Diagnostic Accuracy of Serum Cystatin C for the Evaluation of Renal Dysfunction in Diabetic Patients: A Meta‐Analysis
Shi‐kun Yang, Jun Liu, Xian‐ming Zhang, Chun Hu, Wei Zhang, Lin Sun, Hao Zhang
Therapeutic Apheresis and Dialysis.2016; 20(6): 579. CrossRef
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La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine.2016; 12(4): 243. CrossRef
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Jeffrey W Meeusen, Andrew D Rule, Nikolay Voskoboev, Nikola A Baumann, John C Lieske
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Serum Cystatin C Reflects the Progress of Albuminuria: Jeong Seon Yoo, Young Mi Lee, Eun Hae Lee, Ji Woon Kim, Shin Young Lee, Ki-Cheon Jeong, Shin Ae Kang, Jong Suk Park, Joo Young Nam, Chul Woo Ahn, Young Duk Song, Kyung Rae Kim; Diabetes Metab J. 2011;35(6):602-609. Published online December 26, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.6.602

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Background

Research on the relationship between urinary albumin excretion and serum cystatin C in diabetes is restricted to cross-sectional studies. In this study, we investigated how well serial measurements of serum cystatin C level reflect changes in the urinary albumin excretion rate.

Methods

We enrolled and retrospectively collected data on 1,058 participants with type 2 diabetes who were older than 18 years and who had more than 3 years of follow-up with serial measurements of albuminuria and serum cystatin C at an outpatient clinic.

Results

With the use of a linear mixed model, we found that the albuminuria level for each patient over time corresponded with the annual change in serum cystatin C-based estimated glomerular filtration rate (cysC-eGFR) but did not correspond with the creatinine-based eGFR calculated by the modification of diet in renal disease formula (MDRD-eGFR). The discrepancy in the direction of the trend was smaller with cysC-eGFR than with MDRD-eGFR.

Conclusion

Serum cystatin C level reflects the trend in albuminuria level more accurately than serum creatinine level in Korean type 2 diabetes mellitus patients.

Citations

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Assessment of Cystatin C and Microalbumin as Biomarkers for Nephropathy in Patients with Type 2 Diabetes Mellitus
Bhuneshwar Yadav, Shashidhar K.N, Raveesha A, Muninarayana C.
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Eugene Han, Mi Kyung Kim, Byoung Kuk Jang, Hye Soon Kim
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Yan Shi, Feng Gao, Xiaoli Yang, Dongwei Liu, Qiuxia Han, Zhangsuo Liu, Hanyu Zhu, Yong Shen
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NourhanA Heiba, ManalS Negm, MaalyM Mabrouk, MohamedH Abou-Freikha
Tanta Medical Journal.2020; 48(2): 91. CrossRef
Lower Leg Fat Depots Are Associated with Albuminuria Independently of Obesity, Insulin Resistance, and Metabolic Syndrome (Korea National Health and Nutrition Examination Surveys 2008 to 2011)
Eugene Han, Nan Hee Cho, Mi Kyung Kim, Hye Soon Kim
Diabetes & Metabolism Journal.2019; 43(4): 461. CrossRef
Evaluation of creatinine-based and cystatin C-based equations for estimation of glomerular filtration rate in type 1 diabetic patients
Caroline Pereira Domingueti, Rodrigo Bastos Fóscolo, Ana Cristina Simões e Silva, Luci Maria S. Dusse, Janice Sepúlveda Reis, Maria das Graças Carvalho, Ana Paula Fernandes, Karina Braga Gomes
Archives of Endocrinology and Metabolism.2016; 60(2): 108. CrossRef

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