{"id":29578,"date":"2026-01-07T04:27:00","date_gmt":"2026-01-06T20:27:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29578"},"modified":"2026-01-07T05:52:53","modified_gmt":"2026-01-06T21:52:53","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%9f%ba%e4%ba%8e%e8%82%8c%e9%85%90%e5%92%8c%e5%85%89%e6%8a%91%e7%b4%a0c%e8%ae%a1%e7%ae%97%e7%9a%84egfr%e5%b7%ae%e5%bc%82%e5%8f%8a%e4%b8%b4%e5%ba%8a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29578","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u57fa\u4e8e\u808c\u9150\u548c\u5149\u6291\u7d20C\u8ba1\u7b97\u7684eGFR\u5dee\u5f02\u53ca\u4e34\u5e8a\u9884\u540e"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Discordance in Creatinine- and Cystatin C-Based eGFR and Clinical Outcomes: A Meta-Analysis<\/h1>\n\n\n\n

Michelle M. Estrella, Shoshana H. Ballew, Yingying Sang, et al<\/h3>\n\n\n\n

JAMA Published Online: November 7, 2025<\/h3>\n\n\n\n

doi: 10.1001\/jama.2025.17578<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Do individuals with a cystatin C\u2013based estimated glomerular filtration rate (eGFRcys) value at least 30% lower than their creatinine-based estimated glomerular filtration rate (eGFRcr) have higher rates of mortality, cardiovascular events, and kidney failure compared with individuals whose eGFRcys is not at least 30% lower than their eGFRcr?<\/p>\n\n\n\n

Findings<\/strong>  In this individual participant\u2013level meta-analysis of 821\u202f327 participants from 23 cohorts, an eGFRcys at least 30% lower than eGFRcr was associated with higher mortality, cardiovascular events, and kidney failure with replacement therapy, compared with individuals whose eGFRcys was not at least 30% lower than their eGFRcr.<\/p>\n\n\n\n

Meaning<\/strong>  An eGFRcys value at least 30% lower than eGFRcr was associated with higher rates of mortality, cardiovascular events, and kidney failure with replacement therapy.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Estimated glomerular filtration rates (eGFRs) can differ according to whether creatinine or cystatin C is used for the eGFR calculation, but the prevalence and importance of these differences remain unclear.<\/p>\n\n\n\n

Objectives<\/strong>  To evaluate the prevalence of a discordance between cystatin C\u2013based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr), identify characteristics associated with greater discordance, and evaluate associations of discordance with adverse outcomes.<\/p>\n\n\n\n

Data Sources<\/strong>  Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC).<\/p>\n\n\n\n

Study Selection<\/strong>  Participants with concurrent cystatin C and creatinine measurements and clinical outcome measurement.<\/p>\n\n\n\n

Data Extraction and Synthesis<\/strong>  Between April 2024 and August 2025, data were synthesized using individual-level meta-analysis.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary independent measurement was a large negative eGFR difference (eGFRdiff), defined as an eGFRcys that was at least 30% lower than eGFRcr. Secondary (dependent) outcomes included all-cause and cardiovascular mortality, atherosclerotic cardiovascular disease, heart failure, and kidney failure with replacement therapy.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 821\u202f327 individuals from 23 outpatient cohorts (mean [SD] age, 59 [12] years; 48% female; 13.5% with diabetes; 40% with hypertension) and 39\u202f639 individuals from 2 inpatient cohorts (mean [SD] age, 67 [16] years; 31% female; 30% with diabetes; 72% with hypertension) were included. Among outpatient participants, 11% had a large negative eGFRdiff (range, 3%-50%). Among inpatients, 35% had a large negative eGFRdiff. Among outpatient participants, at a mean (SD) follow-up of 11 (4) years, a large negative eGFRdiff, compared with an eGFRdiff between \u221230% and 30%, was associated with higher rates of all-cause mortality (28.4 vs 16.8 per 1000 person-years [PY]; hazard ratio [HR], 1.69 [95% CI, 1.57-1.82]), cardiovascular mortality (6.1 vs 3.8 per 1000 PY; HR, 1.61 [95% CI, 1.48-1.76]), atherosclerotic cardiovascular disease (13.3 vs 9.8 per 1000 PY; HR, 1.35 [95% CI, 1.27-1.44]), heart failure (13.2 vs 8.6 per 1000 PY; HR, 1.54 [95% CI, 1.40-1.68]), and kidney failure with replacement therapy (2.7 vs 2.1 per 1000 PY; HR, 1.29 [95% CI, 1.13-1.47]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In the CKD-PC, 11% of outpatient participants and 35% of hospitalized patients had an eGFRcys that was at least 30% lower than their eGFRcr. In the outpatient setting, presence of eGFRcys at least 30% lower than eGFRcr was associated with significantly higher rates of all-cause mortality, cardiovascular events, and kidney failure.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Discordance in Creatinine- […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29578"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29578"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29578\/revisions"}],"predecessor-version":[{"id":29853,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29578\/revisions\/29853"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29578"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29578"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29578"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}