Cystatin C-creatinine eGFR discordance and all-cause mortality in adults with preserved creatinine-based kidney function: a dual-cohort study.

Authors

Chengkai Wang, Gang Yin

Published in

International urology and nephrology. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Creatinine-based estimated glomerular filtration rate (eGFRcr) is widely used to assess kidney function. In middle-aged and older adults, however, serum creatinine can be influenced by muscle mass and other non-GFR determinants. We examined whether cystatin C-creatinine eGFR discordance is associated with mortality among adults with preserved creatinine-based kidney function.
We analyzed the China Health and Retirement Longitudinal Study (CHARLS) as the primary longitudinal cohort and the National Health and Nutrition Examination Survey (NHANES) 1999-2002 as an external population-based cohort. Analyses excluded participants with prevalent major cardiovascular disease and were restricted to adults with eGFRcr ≥ 60 mL/min/1.73 m². The primary exposure was negative eGFR discordance, defined as eGFRcys/eGFRcr ≤ 0.70. Cox models were used in CHARLS, and survey-weighted Cox models were used in NHANES. Dynamic discordance patterns, restricted cubic splines, prediction analyses, subgroup analyses, multiple imputation, competing-risk models, and sensitivity analyses using relative and absolute discordance definitions were performed.
The CHARLS baseline cohort included 7210 participants, the CHARLS dynamic landmark cohort included 4125 participants, and the NHANES mortality analytic cohort included 984 participants. Baseline eGFR discordance was associated with higher all-cause mortality in CHARLS (hazard ratio [HR], 1.627; 95% confidence interval [CI], 1.389-1.907; P < 0.001) and in NHANES (HR, 1.694; 95% CI, 1.385-2.073; P < 0.001). Associations with nonfatal cardiovascular outcomes in CHARLS and heart disease mortality in NHANES were not robust after multivariable adjustment. In the CHARLS dynamic landmark cohort, remitted discordance and persistent discordance were associated with higher post-2015 all-cause mortality. Prediction analyses showed only modest incremental value beyond conventional risk factors.
Among adults with preserved creatinine-based kidney function, substantially lower eGFRcys relative to eGFRcr was associated with higher all-cause mortality in two population-based cohorts. These findings suggest that cystatin C-creatinine eGFR discordance may provide additional prognostic information when eGFRcr appears preserved, although its incremental predictive value was modest.

PMID:
42410266
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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