Cystatin C and albuminuria as risk factors for development of CKD stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA)

Am J Kidney Dis. 2011 Jun;57(6):832-40. doi: 10.1053/j.ajkd.2010.11.021. Epub 2011 Feb 5.


Background: The growing burden and morbidity of chronic kidney disease (CKD) warrant effective strategies for identifying those at increased risk. We examined the association of cystatin C level and albuminuria with the development of CKD stage 3.

Study design: Prospective observational study.

Setting & participants: 5,422 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2).

Predictor: Participants were categorized into 4 mutually exclusive groups: the presence or absence of microalbuminuria (albumin-creatinine ratio >17 and >25 μg/mg in men and women, respectively) in those with or without cystatin C level ≥1.0 mg/L.

Outcomes & measurements: Incident CKD stage 3 was defined as eGFR <60 mL/min/1.73 m(2) at the third or fourth visit and an annual decrease >1 mL/min/1.73 m(2). Poisson regression was used to evaluate incident rate ratios in unadjusted and adjusted analyses that include baseline eGFR.

Results: Mean age was 61 years, 49% were men, 38% were white, 11% had diabetes, 13.7% had cystatin C level ≥1 mg/L, 8.4% had microalbuminuria, and 2.7% had cystatin C level ≥1 mg/L with microalbuminuria. 554 (10%) participants developed CKD stage 3 during a median follow-up of 4.7 years, and adjusted incidence rate ratios were 1.57 (95% CI, 1.19-2.07), 1.37 (95% CI, 1.13-1.66), and 2.12 (95% CI, 1.61-2.80) in those with microalbuminuria, cystatin C level ≥1 mg/L, and both, respectively, compared with those with neither.

Limitations: Relatively short follow-up and absence of measured GFR.

Conclusions: Cystatin C level and microalbuminuria are independent risk factors for incident CKD stage 3 and could be useful as screening tools to identify those at increased risk.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Albuminuria / blood
  • Albuminuria / complications*
  • Albuminuria / ethnology
  • Biomarkers / blood
  • Cystatin C / blood*
  • Disease Progression
  • Ethnic Groups*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / ethnology*
  • Kidney Failure, Chronic / etiology
  • Male
  • Middle Aged
  • Nephelometry and Turbidimetry
  • Prognosis
  • Retrospective Studies
  • Risk Factors


  • Biomarkers
  • Cystatin C