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논문분류	춘계학술대회 초록집
제목	Reclassification of Chronic Kidney Disease Stage Using Cystatin CBased eGFR in a Mongolian Screening Population
저자	Anujin Surenjav
출판정보	2026; 2026(1):
키워드	Cystatin C, Creatinine, CKD stage reclassification, Estimated glomerular filtration rate, Chronic kidney disease
초록	Objectives: Serum creatinine is the most commonly used marker for estimating glomerular filtration rate, but it is influenced by muscle mass and other non-renal factors. Cystatin C has been proposed as an alternative filtration marker that may improve risk assessment. However, its clinical relevance in preventive screening populations remains unclear, particularly in Central Asian countries. Methods: We conducted a cross-sectional study of 684 adults who undergoing routine preventive health examinations in Mongolia. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation and a cystatin C–based equation. Agreement between the two methods was evaluated using Pearson correlation, paired t-test, Bland–Altman analysis, and Cohen’s kappa statistics. Multivariable logistic regression analysis was performed to identify factors associated with stage reclassification. Results: Creatinine- and cystatin C-based estimated glomerular filtration rate showed moderate correlation (r = 0.676, p < 0.001). The mean difference between the two methods was −5.7 ml/min, with limits of agreement ranging from −36.9 to +25.5 ml/min, indicating substantial variability between individuals. A clinically meaningful discrepancy of ≥20 ml/min was observed in 5.1% of participants and was more frequent among individuals younger than 40 years (12.0%, p < 0.001). Despite the modest mean difference, CKD stage classification differed significantly between methods (p < 0.001). Overall, 27.6% of participants were reclassified into a different stage when cystatin C–based estimation was applied. Agreement between stage classifications was fair (κ = 0.338, p < 0.001). Cystatin C–based eGFR identified additional individuals with reduced kidney function who were not classified as having CKD using creatinine alone. Conclusion: In a preventive screening population of Mongolian adults, cystatin C-based estimation substantially altered chronic kidney disease stage classification despite a modest mean difference compared with creatinine-based estimation. Cystatin C may improve early risk stratification, particularly in individuals with preserved kidney function.
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