Cystatin C as a marker of the rapid development of the atherosclerosis in patients with diabetes mellitus and chronic kidney disease

Abstract

Introduction. The relationship between kidney dysfunction and cardiovascular system is multifaceted. Thus, the value of such a potential marker of glomerular filtration rate (GFR) as cystatin C cannot be underestimated as a predictor of the development of cardiovascular complications and atherogenesis factor in diabetes mellitus (DM) and chronic kidney disease (CKD). Objective was to evaluate the role of cystatin C as an atherogenesis factor in patients with DM and CKD. Materials and methods. The study involved 514 patients aged 25 to 80 years (the group of interest (n=449), the control group (n=65)). All patients underwent clinical and laboratory tests, sonography of the lower extremities vessels and brachiocephalic arteries (BCA). Results. The thickness of the intima-media complex increased with an increase of cystatin C level in the right carotid artery (CA) (from 0.80 [0.70; 0.90] mm to 0.97 [0.90; 1.02] mm) and in the left CA (from 0.90 [0.80; 0.94] mm to 0.92 [0.90; 1.10] mm). Logistic regression analysis demonstrated that an increase of cystatin C level > 0.93 mg/l raises the risk of intima-media thickening by 2.5 times (OR 2.505, p=0.042) and by 5 times when increase of cystatin C>1.38 mg/l (OR 4.718, p=0.001). At the same time, the association with homocysteine was unreliable (p=0.058). The level of cystatin C ≥0.82 mg/l with a sensitivity of 72 % and a specificity of 52 % allowed to predict the development of subclinical atherosclerosis in patients with DM and CKD (ROC AUC – 0.739). Conclusion. Cystatin C is not only a highly sensitive and accurate indicator of GFR, capable of detecting early stages of renal dysfunction, but also a highly effective predictive marker of atherosclerotic process in patients with DM and CKD.