Detection of Chronic Kidney Disease with Creatinine, Cystatin C, and Urine Albumin-to-Creatinine Ratio and Association with Progression to End-Stage Renal Disease and Mortality

A test that simultaneously assessed several biological markers of kidney disease led to more precise estimates of risk for death and kidney failure.

Misdiagnoses of chronic kidney disease (CKD) can result from tests that rely solely on creatinine levels. This study evaluated a test that involved two additional CKD biomarkers: albumin-to-creatinine ratios (ACR) and cystatin C.

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study assessed kidney function in more than 30,000 Black and White Americans older than 45. Using REGARDS data, this study evaluated ACR and the presence of cystatin C in patients diagnosed as having CKD. The authors compared the risk of death and kidney failure in these patients with patients tested for CKD using creatinine-only techniques.

Key Findings:

  • Using cystatin C and ACR to define kidney disease identified a greater number of individuals at high risk for death and end-stage renal disease.
  • When the definition of kidney disease included measures of cystatin C, the risk group changed for a significant percentage of the REGARDS cohort.

This study found that cystatin C and ACRs can detect kidney disease in patients who might be missed in tests that measure only creatinine levels.