Cystatin C Enhances Glomerular Filtration Rate Estimating Equations in Kidney Transplant Recipients

Overview

Journal Am J Nephrol

Publisher Karger

Specialty Nephrology

Date 2014 Jan 25

PMID 24457184

Citations 7

Authors

Aleksandra Kukla

Naim Issa

Scott Jackson

Richard Spong

Meredith C Foster

Arthur J Matas

Michael S Mauer

John H Eckfeldt

Hassan N Ibrahim

Affiliations

Soon will be listed here.

Abstract

Background: The glomerular filtration rate (GFR) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR. Whether this equation performs well in kidney transplant recipients cross-sectionally, and more importantly, over time has not been addressed.

Methods: We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial (NCT 00067990): Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine (eGFR (CKD-EPI-Creat+CysC)), cystatin C alone (eGFR (CKD-EPI-CysC)), creatinine alone (eGFR (CKD-EPI-Creat)) and the Modification of Diet in Renal Disease study equation (eGFR (MDRD)). Iothalamate GFR served as a standard (mGFR).

Results: mGFR, serum creatinine, and cystatin C shortly after transplant were 56.1 ± 17.0 ml/min/1.73 m(2), 1.2 ± 0.4 mg/dl, and 1.2 ± 0.3 mg/l respectively. eGFR (CKD-EPI-Creat+CysC) was most precise (R(2) = 0.50) but slightly more biased than eGFR (MDRD); 9.0 ± 12.7 versus 6.4 ± 15.8 ml/min/1.73 m(2), respectively. This improved precision was most evident in recipients with mGFR >60 ml/min/1.73 m(2). For relative accuracy, eGFR (MDRD) and eGFR (CKD-EPI-Creat+CysC) had the highest percentage of estimates falling within 30% of mGFR; 75.8 and 68.9%, respectively. Longitudinally, equations incorporating cystatin C most closely paralleled the change in mGFR.

Conclusion: eGFR (CKD-EPI-Creat+CysC) is more precise and reflects GFR change over time reasonably well. eGFR (MDRD) had superior performance in recipients with mGFR between 30 and 60 ml/min/1.73 m(2).

Citing Articles

Immunosuppression and transplantation-related characteristics affect the difference between eGFR equations based on creatinine compared to cystatin C in kidney transplant recipients.

Weidmann L, Laux C, Castrezana Lopez K, Harmacek D, George B, Moos S Clin Kidney J. 2024; 17(11):sfae253.

PMID: 39502371 PMC: 11536772. DOI: 10.1093/ckj/sfae253.

Antihypertensive treatment for kidney transplant recipients.

Natale P, Mooi P, Palmer S, Cross N, Cooper T, Webster A Cochrane Database Syst Rev. 2024; 7():CD003598.

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Metabolomics in diabetic nephropathy: Unveiling novel biomarkers for diagnosis (Review).

Luo Y, Zhang W, Qin G Mol Med Rep. 2024; 30(3).

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Serum myo-inositol and valine improve metabolomic-based estimated glomerular filtration rate among kidney transplant recipients.

Meeusen J, Stammler F, Dasari S, Schiffer E, Lieske J Front Med (Lausanne). 2022; 9:988989.

PMID: 36465899 PMC: 9712186. DOI: 10.3389/fmed.2022.988989.

Cystatin C: A Primer for Pharmacists.

Teaford H, Barreto J, Vollmer K, Rule A, Barreto E Pharmacy (Basel). 2020; 8(1).

PMID: 32182861 PMC: 7151673. DOI: 10.3390/pharmacy8010035.

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