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Use of cystatin C levels in estimating renal function and prognosis in patients with chronic systolic heart failure
  1. Kevin Damman1,
  2. Pim van der Harst1,
  3. Tom D J Smilde1,
  4. A A Voors1,
  5. Gerjan Navis2,
  6. Dirk J van Veldhuisen1,
  7. Hans L Hillege1,3
  1. 1Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
  2. 2Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands
  3. 3Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands
  1. Correspondence to Dr Kevin Damman, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, P O Box 30001, 9700 RB Groningen, The Netherlands; k.damman{at}


Background Estimates of glomerular filtration rate (GFR), including creatinine and creatinine based formulae, are inaccurate in extremes of GFR and substantially biased in patients with chronic heart failure (CHF).

Objective To investigate whether serum cystatin C levels would be a better, more accurate and simple alternative for estimation of GFR and prognosis in CHF.

Design Cohort study.

Setting Chronic heart failure.

Patients, interventions and main outcome measure In 102 CHF patients, the correlation between GFR as estimated by 125I-iothalamate clearance (GFRIOTH), the modification of diet in renal disease formula (GFRMDRD) and cystatin C was investigated. The combined endpoint consisted of the first occurrence of all cause mortality, heart transplantation or admission for CHF within 24 months.

Results Mean age was 58±12 years; 77% were male. Mean left ventricular ejection fraction was 28±9%. Mean GFRIOTH was 75±27 ml/min/1.73 m2, while median cystatin C levels were 0.80 (0.69–1.02) mg/l. GFRIOTH was strongly correlated with all renal function estimates, including 1/cystatin C (r=0.867, p<0.001). GFRIOTH was better predicted by 1/cystatin C compared to 1/serum creatinine (z=3.12, p=0.002), but equally predicted compared to GFRMDRD (z=0.92, p=0.356). Serum 1/cystatin C was a strong independent predictor of prognosis (HR: 2.27 per SD increase, 95% CI 1.12 to 4.63), comparable to GFRMDRD.

Conclusions Cystatin C is an accurate and easy estimate of renal function with prognostic properties superior to serum creatinine and similar to creatinine based formulae in patients with CHF.

  • Cystatin C
  • renal function
  • heart failure
  • prognosis
  • creatinine
  • haemodynamics
  • heart failure treatment
  • renin-angiotensin system
  • renal disease
  • coronary intervention
  • papers on telomere or accerated ageing
  • drug therapy
  • chronic heart failure
  • vascular endothelium
  • vascular biology
  • stent interventions
  • coronary artery restenosis
  • coronary artery disease
  • autonomic failure
  • renal disease
  • statistics
  • baroreceptors
  • clinical trials
  • risk stratification
  • epidemiology

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  • Competing interests None.

  • Ethics approval Medical Ethical Committee, University Medical Center Groningen.

  • Provenance and peer review Not commissioned; externally peer reviewed.