American Journal of Kidney Diseases
Volume 51, Issue 3 , Pages 385-394, March 2008

Serum Cystatin C in the United States: The Third National Health and Nutrition Examination Survey (NHANES III)

  • Anna Köttgen, MD, MPH

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Elizabeth Selvin, PhD, MPH

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Lesley A. Stevens, MD, MS

      Affiliations

    • Division of Nephrology, Tufts-New England Medical Center, Boston, MA
    • ,
  • Andrew S. Levey, MD

      Affiliations

    • Division of Nephrology, Tufts-New England Medical Center, Boston, MA
    • ,
  • Frederick Van Lente, PhD

      Affiliations

    • Department of Clinical Pathology, Cleveland Clinic Foundation, Cleveland, OH
    • ,
  • Josef Coresh, MD, PhD

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
    • Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Hospital, Baltimore, MD
    • Department of Medicine, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Hospital, Baltimore, MD.
    • Corresponding Author InformationAddress correspondence to Josef Coresh, MD, PhD, Welch Center for Prevention, Epidemiology & Clinical Research, 2024 E Monument St, Baltimore, MD 21287.

Received 2 September 2007; accepted 17 November 2007.

Background

Serum cystatin C increasingly is used as a marker of glomerular filtration rate and cardiovascular risk. However, information for serum cystatin C levels in the general population, specifically across a wide age range and different ethnicities, is lacking.

Objectives

To determine nationally representative serum cystatin C levels, estimate the prevalence of increased cystatin C levels in the general population, and identify factors associated with increased cystatin C levels.

Study Design

Cross-sectional survey.

Setting and Participants

A nationally representative subsample of 7,596 participants aged 12 years or older in the Third National Health and Nutrition Examination Survey conducted in 1988-1994.

Predictors

Age, sex, race/ethnicity, risk factors for chronic kidney disease.

Outcomes

Continuous serum cystatin C levels and serum cystatin C level greater than 1.12 mg/L.

Measurements

Cystatin C was measured in 2006 from stored sera by using an automated particle-enhanced nephelometric assay.

Results

Overall median serum cystatin C level was 0.85 mg/L. Median cystatin C levels increased steeply with age and were greater in males and non-Hispanic white persons, even in a healthy subgroup of 20- to 39-year-olds. Prevalences of increased serum cystatin C levels (>1.12 mg/L) were 1%, 41%, and greater than 50% in all persons aged younger than 20 years, 60 years or older, and 80 years or older. In persons aged 60 years and older, older age, non-Hispanic white ethnicity, hypertension, current smoking, lower levels of education and high-density lipoprotein cholesterol, and increased body mass index, C-reactive protein, and triglyceride values were associated significantly with increased serum cystatin C levels.

Limitations

No measured glomerular filtration rate, single measurement of cystatin C, cross-sectional study design.

Conclusions

Serum cystatin C level is related to sex and ethnicity, even in young healthy individuals. The prevalence of increased cystatin C levels increases dramatically with age, reaching greater than 50% after the age of 80 years in both sexes and all ethnic groups.

Index Words: Cystatin C levels, US population, NHANES III, predictors, glomerular filtration rate (GFR)-estimating equations

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 Because an author of this manuscript is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an Associate Editor (Marcello Tonelli, MD, University of Alberta) who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.

PII: S0272-6386(07)01595-8

doi:10.1053/j.ajkd.2007.11.019

Refers to article:

  • Cystatin C: Research Priorities Targeted to Clinical Decision Making

    Michael G. Shlipak
    American Journal of Kidney Diseases March 2008 (Vol. 51, Issue 3, Pages 358-361)

American Journal of Kidney Diseases
Volume 51, Issue 3 , Pages 385-394, March 2008

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