Serum levels of
creatinine,
cystatin C, or β trace
protein allow estimation of GFR, but whether these markers contribute additional prognostic information beyond that reflected in GFR is unknown. Here, we analyzed data from the Modification of Diet in Renal Disease study, which provided baseline levels of these markers for 816 participants with a median follow-up of 16.6 years. We examined associations between the reciprocals of these filtration markers and (125)I
iothalamate GFR, expressed per SD, with
kidney failure and mortality. In univariate analysis, lower GFR and higher levels of each filtration marker associated with a higher risk for all outcomes. After adjustment for GFR in a Cox proportional hazards model, higher
creatinine associated with a higher risk for
kidney failure but a lower risk for all-cause mortality. Higher
cystatin C and β trace
protein associated with a higher risk for both
kidney failure and all-cause mortality. In models including either
cystatin C or β trace
protein, the association of GFR with all-cause mortality was no longer significant after the addition of the filtration marker, suggesting the possibility of multicollinearity. In summary, after adjustment for GFR, levels of
creatinine,
cystatin C, and β trace
protein, each remained directly associated with
kidney failure but differed with respect to their associations with mortality. These differences may be a result of non-GFR-related associations of filtration markers, residual confounding by GFR, or collinearity between the filtration markers and GFR. β trace
protein and
cystatin C seem to provide more consistent prognostic information than
creatinine.