Urinary cystatin C as a potential risk marker for cardiovascular disease and chronic kidney disease in patients with obesity and metabolic syndrome

Clin J Am Soc Nephrol. 2011 Feb;6(2):265-73. doi: 10.2215/CJN.04830610. Epub 2010 Nov 4.

Abstract

Background and objectives: Obesity and metabolic syndrome (MS) increase the risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and all-cause mortality. Serum cystatin C (S-CysC), a marker of GFR, has been shown to be associated with CVD and CKD. This study was designed to elucidate the association of urinary CysC (U-CysC), a marker of renal tubular dysfunction, with CVD and CKD risk factors in patients with obesity and MS.

Design, setting, participants, & measurements: The U-CysC-creatinine ratio (UCCR) was examined in 343 Japanese obese outpatients enrolled in the multi-centered Japan Obesity and Metabolic Syndrome Study.

Results: UCCR was positively correlated with urine albumin-creatinine ratio (UACR) and S-CysC and negatively correlated with estimated GFR (eGFR). Among obese patients, UCCR was significantly higher in MS patients than in non-MS patients. UCCR had significant correlations with the number of components of MS and arterial stiffness, all of which are CVD predictors, similarly to UACR (P<0.05). Interestingly, diet- and exercise-induced weight reduction for 3 months significantly decreased only UCCR among all of the renal markers examined (P<0.01), in parallel with the decrease in BMI, HbA1c, and arterial stiffness, suggesting the beneficial effect of weight reduction on renal tubular dysfunction.

Conclusions: This study demonstrates that UCCR is significantly associated with renal dysfunction, the severity of MS, arterial stiffness, and weight change in obese patients. The data of this study suggest that U-CysC could serve as a CVD and CKD risk factor in patients with obesity and MS.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Albuminuria / etiology
  • Albuminuria / urine
  • Analysis of Variance
  • Arteries / physiopathology
  • Biomarkers / blood
  • Biomarkers / urine
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / urine
  • Chi-Square Distribution
  • Chronic Disease
  • Creatinine / urine
  • Cross-Sectional Studies
  • Cystatin C / urine*
  • Disease Progression
  • Elasticity
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Japan
  • Kidney Diseases / etiology*
  • Kidney Diseases / physiopathology
  • Kidney Diseases / urine
  • Male
  • Metabolic Syndrome / complications*
  • Metabolic Syndrome / physiopathology
  • Metabolic Syndrome / urine
  • Middle Aged
  • Obesity / complications*
  • Obesity / physiopathology
  • Obesity / therapy
  • Obesity / urine
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Severity of Illness Index
  • Weight Loss

Substances

  • Biomarkers
  • CST3 protein, human
  • Cystatin C
  • Creatinine