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American Journal of Epidemiology Advance Access originally published online on October 11, 2006
American Journal of Epidemiology 2006 164(12):1180-1189; doi:10.1093/aje/kwj333
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

Cystatin C and Measures of Physical Function in Elderly Adults

The Health, Aging, and Body Composition (HABC) Study

Michelle C. Odden1, Glenn M. Chertow2, Linda F. Fried3,4, Anne B. Newman3, Stephanie Connelly5, Sara Angleman5, Tamara B. Harris5, Eleanor M. Simonsick5, Michael G. Shlipak1,6 and for the HABC Study

1 General Internal Medicine Section, San Francisco VA Medical Center, San Francisco, CA
2 Department of Nephrology, University of California, San Francisco, San Francisco, CA
3 Department of Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
4 Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
5 National Institute on Aging, National Institutes of Health, Bethesda, MD
6 Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, CA

Correspondence to Dr. Michael G. Shlipak, General Internal Medicine Section, VA Medical Center (111A1), 4150 Clement Street, San Francisco, CA 94121 (e-mail: shlip{at}itsa.ucsf.edu).

Most studies of the relation between kidney function and physical function have been conducted in persons with advanced kidney disease and have used creatinine-based measures of kidney function. Cystatin C concentration is a measure of kidney function that is independent of muscle mass, unlike creatinine. Using baseline data on 3,043 elderly adults from the Health, Aging, and Body Composition Study (Blacks and Whites recruited from Pittsburgh, Pennsylvania, and Memphis, Tennessee, in 1997–1998), the authors examined the cross-sectional association between cystatin C level and performance on several tests of physical function. After adjustment for demographic and lifestyle variables, chronic health conditions, and inflammation, each standard-deviation (0.34 mg/liter) increase in cystatin C concentration was associated with 1.32 odds (95% confidence interval (CI): 1.20, 1.46) of not completing a 400-m walk, a 10.9-second (95% CI: 8.1, 13.8) slower 400-m walk time, a 0.11-point (95% CI: 0.09, 0.13) reduction in lower extremity performance score, a 1.12-kg (95% CI: 0.83, 1.40) lower grip strength, and a 4.7-nm (95% CI: 3.5, 5.9) lower knee extension strength. In contrast, when kidney function was measured by estimated glomerular filtration rate, the association of kidney function with physical function was only evident below 60 ml/minute/1.73 m2. In these older adults, mild decrements in kidney function, as measured by cystatin C concentration, were associated with poorer physical function.

aging; cystatin C; exercise tolerance; kidney diseases; muscle weakness; walking

Abbreviations: CI, confidence interval; eGFR, estimated glomerular filtration rate; Health ABC, Health, Aging, and Body Composition; MDRD, Modification of Diet in Renal Disease


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