Combined Association of Albuminuria and Cystatin C–Based Estimated GFR With Mortality, Coronary Heart Disease, and Heart Failure Outcomes: The Atherosclerosis Risk in Communities (ARIC) Study

American Journal of Kidney Diseases, 04/27/2012

Mildly decreased cystatin C–based estimated glomerular filtration rate (eGFRcys) and mild albuminuria independently contributed to the risk of mortality, Coronary Heart Disease (CHD), and heart failure. Even minimally decreased eGFRcys (75–89 mL/min/1.73 m2) is associated with increased risk in the presence of mild albuminuria. Combining the 2 markers is useful for improved risk stratification even in those without clinical chronic kidney disease (CKD).


  • Prospective cohort.
  • 10,403 ARIC (Atherosclerosis Risk in Communities) Study participants followed up for a median of 10.2 years.
  • Mortality, coronary heart disease (CHD), and heart failure, as well as a composite of any of these separate outcomes.


  • Both decreased eGFRcys and albuminuria were associated independently with the composite outcome, as well as mortality, CHD, and heart failure.
  • Although eGFRcys of 75–89 mL/min/1.73 m2 in the absence of albuminuria (albumin–creatinine ratio [ACR] <10 mg/g) or albuminuria with ACR of 10–29 mg/g with normal eGFRcys (90–104 mL/min/1.73 m2) was not associated significantly with any outcome compared with eGFRcys of 90–104 mL/min/1.73 m2 and ACR <10 mg/g, the risk of each outcome was significantly higher in those with both eGFRcys of 75–89 mL/min/1.73 m2 and ACR of 10–29 mg/g (for mortality, HR of 1.4 [95% CI, 1.1–2.0]; for CHD, HR of 1.9 [95% CI, 1.4–2.6]; for heart failure, HR of 1.8 [95% CI, 1.2–2.7]).
  • Combining the 2 markers improved risk classification for all outcomes (P < 0.001), even in those without overt CKD.

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