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Background/Aims: The relationship between carotid artery plaque burden, phenotype and serum cystatin C at normal and impaired renal function is still unclear. Methods: Demographic characteristics, carotid ultrasonography and other relevant information of 1,477 patients were collected. The association of carotid artery plaque burden, plaque phenotype with serum cystatin C was evaluated by strategy analysis based on renal function. Results: Serum cystatin C (OR=2.05, 95% CI: 1.83-2.29, P<.01) was a risk factor of stable plaque among patients with normal glomerular filtration rate. However, in the patients with mild impaired renal function, serum cystatin C was not only a risk factor for stable plaque (OR=1.60, 95%CI: 1.43-1.78, P<.001) but also was a risk factor for unstable plaque (OR=1.21, 95%CI: 1.10-1.32, P<.001). The smoothing function curve and a three-piecewise linear regression revealed that a nonlinear relationship was observed between serum cystatin C and plaque burden. When serum cystatin C was in the range of 0.75-1.30 (mg/L), the plaque burden tended to increase. Conclusion: In normal renal function, serum cystatin C may confer stability of plaques. In mildly impaired renal function, serum cystatin C is a risk predictor of plaques. In normal renal function circumstances, serum cystatin C may benefit to the stability of plaques. In mild impaired renal function circumstances, serum cystatin C are a risk predictors of plaques. [ABSTRACT FROM AUTHOR]