血清胱抑素C作為泌尿道畸形兒童慢性腎臟病風險預測指標之研究

林冠廷¹、楊宇祥¹

¹臺北市立萬芳醫院─委託臺北醫學大學辦理 泌尿科

Retrospective Cohort Study on the Prognostic Significance of Serum Cystatin C for Predicting Chronic Kidney Disease Risk in Pediatric Patients with urologic malformations

Kuan-Ting Lin¹, Yu-Hsiang Yang¹

¹Department of Urology, Wan Fang Hospital, Taipei Medical University

Abstract

Objectives

To evaluate the prognostic value of serum cystatin C in predicting the 10-year risk of major adverse kidney event (MAKE), among pediatric patients with urologic malformations.

Methods

This retrospective cohort study utilised data from the TriNetX global federated research network, comprising electronic health records from multiple healthcare organizations. Pediatric patients aged 0–18 years with a diagnosis of urologic malformations, including but not limited to congenital anomalies of the urinary tract, vesicoureteral reflux, obstructive uropathy, neurogenic bladder, and spina bifida. Patients were identified using validated ICD-10-CM codes and included if they had available serum cystatin C measurements. The primary outcome was a composite endpoint of major adverse kidney event (MAKE), defined as the initiation of dialysis, kidney transplantation, diagnosis of chronic kidney disease (CKD), or a recorded estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², occurring within 10 years of the index event. Secondary outcomes included each individual component of the composite outcome.

Results

A total of 2,062 patients were included following 1:1 propensity score matching. The mean follow-up was 1,025 days. Among patients with elevated cystatin C levels (≥1.3 mg/L), 251(39.3%) developed the composite MAKE outcome compared with 114 (29.2%) in those with lower cystatin C levels (<1.3 mg/L), yielding a hazard ratio (HR) of 2.5 (95% CI, 2.003–3.12; p<0.001). Elevated cystatin C was also associated with increased risks of CKD (HR 3.549 95% CI, 2.29–5.501; p<0.001), dialysis (HR 9.092; 95% CI, 1.152–71.764; p=0.0109), Albuminuria (HR,1.831; 95% CI, 1.182–2.; p =0.0059). There were no statistically significant differences between the groups in the incidence of renal transplantation (HR, 0.52; 95% CI, 0.05–5.74; p = 0.59) or decline in estimated glomerular filtration rate (eGFR) to <60 mL/min/1.73 m² (HR, 1.48; 95% CI, 0.83–2.52; p = 0.19).

Conclusions
High serum cystatin C is an independent predictor of CKD and MAKE in pediatric patients with urologic malformations. Routine use of cystatin C may facilitate early risk stratification and guide long-term renal monitoring strategies in this vulnerable population.