{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T20:15:46Z","timestamp":1786133746500,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/100000062","name":"NIDDK","doi-asserted-by":"crossref","award":["K23DK128605"],"award-info":[{"award-number":["K23DK128605"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"NIDDK","doi-asserted-by":"crossref","award":["K24DK92291"],"award-info":[{"award-number":["K24DK92291"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2025,8]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Critical illness is known to acutely decrease eGFRdiff (estimation of GFR by cystatin C\u2212estimation of GFR from serum creatinine [eGFRCr]), presumably because of loss of muscle mass falsely elevating eGFRCr.<\/jats:p>\n <\/jats:list-item>\n \n It is unknown whether this eGFRdiff effect occurs in all-cause hospitalizations and whether the effect persists after hospitalization.<\/jats:p>\n <\/jats:list-item>\n \n More hospitalization was associated with larger decreases in estimation of GFR by cystatin C compared with eGFRCr on measurements months after hospital discharge.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Cystatin C has entered mainstream clinical care as a measure of kidney function, joining serum creatinine, which has been used for almost a century. However, many physicians notice that estimation of GFR from serum creatinine (eGFRCr) and estimation of GFR by cystatin C (eGFRCys) values can differ considerably. Hospitalization with critical illness is known to acutely decrease eGFRdiff (eGFRCys\u2212eGFRCr). However, whether this effect occurs in all-cause hospitalizations and persists after hospitalization is unknown.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Among 5599 adult participants in the Chronic Renal Insufficiency Cohort study with serum creatinine and cystatin C measurements, we estimated the association of six categories of total days of hospitalization between annual study visits (never hospitalized, hospitalized <7, 7 to <14, 14 to <28, 28 to <42, and \u226542 days) and changes in eGFRCr, eGFRCys, and eGFRdiff between those study visits.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Compared with no hospitalization between study visits, increasing days of hospitalization were associated with decreases in eGFRCys (\n e.g<\/jats:italic>\n ., \u22123.30 [95% confidence interval, \u22125.48 to \u22121.13] ml\/min per 1.73 m\n 2<\/jats:sup>\n for \u226542 days of hospitalization, test for trend\n P<\/jats:italic>\n < 0.001), while eGFRCr remained relatively stable (\n e.g<\/jats:italic>\n ., \u22121.12 [\u22122.77 to 0.53] ml\/min per 1.73 m\n 2<\/jats:sup>\n for \u226542 days of hospitalization, test for trend\n P<\/jats:italic>\n = 0.21). The differential effect resulted in eGFRdiff becoming progressively more negative with more total days of hospitalization (test for trend\n P<\/jats:italic>\n < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Prolonged or repeated hospitalization was associated with larger decreases in eGFRCys compared with eGFRCr on measurements months after hospital discharge.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.0000000670","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T12:03:43Z","timestamp":1741694623000},"page":"1585-1591","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Differential Effect of Hospitalization on Cystatin C\u2013 and Creatinine-Based Estimated GFR"],"prefix":"10.1681","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6470-6959","authenticated-orcid":false,"given":"Ian E.","family":"McCoy","sequence":"first","affiliation":[{"name":"Division of Nephrology, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9109-0811","authenticated-orcid":false,"given":"Alan S.","family":"Go","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-6534","authenticated-orcid":false,"given":"Jesse Y.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8669-4530","authenticated-orcid":false,"given":"Xiaoming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony N.","family":"Muiru","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3584-4057","authenticated-orcid":false,"given":"Vallabh O.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8820-5702","authenticated-orcid":false,"given":"Matthew","family":"Weir","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3559-4374","authenticated-orcid":false,"given":"Hernan","family":"Rincon-Choles","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1325-315X","authenticated-orcid":false,"given":"Debbie L.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1454-4282","authenticated-orcid":false,"given":"Amanda","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1210-7115","authenticated-orcid":false,"given":"Bernard","family":"Jaar","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9538-9682","authenticated-orcid":false,"given":"James","family":"Sondheimer","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Wayne State University School of Medicine, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4699-5395","authenticated-orcid":false,"given":"Panduranga S.","family":"Rao","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9735-7473","authenticated-orcid":false,"given":"Laura M.","family":"Dember","sequence":"additional","affiliation":[{"name":"Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8286-9652","authenticated-orcid":false,"given":"Jiang","family":"He","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9035-9126","authenticated-orcid":false,"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas"},{"name":"Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8182-1238","authenticated-orcid":false,"given":"Chi-yuan","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of California San Francisco, San Francisco, California"},{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Chronic Renal Insufficiency Cohort (CRIC) Study 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