Assessment of Estimated Glomerular Filtration Rate Based on Cystatin C in Diabetic Nephropathy

Overview

Journal J Bras Nefrol

Specialty Nephrology

Date 2021 Feb 18

PMID 33599678

Citations 2

Authors

Kadriye Akpinar

Diler Aslan

Semin Melahat Fenkci

Affiliations

Soon will be listed here.

Abstract

Introduction: GFR is estimated by using creatinine and cystatin C to determine renal dysfunction. Our aim was to evaluate estimated GFR (eGFR) based on cystatin C in type 2 diabetic patients with diabetic nephropathy (DN).

Methods: Study group included 52 controls (46% male, age: 54.5±12.4) and 101 diabetic patients (46.5% male, age: 58.2±11). The diabetics were divided into three subgroups according to 24-hour urine albumin: normal to mildly increased (A1) (n=51), moderately increased (A2) (n=25), severely increased (A3) (n=25) albuminuria. Creatinine clearance (CrCl) was determined. Correlations between CrCl and eGFRs estimated according to the CKD-EPI, MDRD, and Cockcroft-Gault (CG) formulas, and ROC curves were evaluated. Data were analyzed using SPSS 22.0.

Results: Only CKD-EPI-cys eGFR was significantly lower in the A1 group than the controls (p=0.021). All GFRs were lower in the A3 group than the control (CKD-EPI-cr, MDRD, CKD-EPI-cys, CKD-EPI-cr-cys: p=0.0001, CG and CrCl: p=0.001) and A1 (for all GFRs p=0.0001) groups. CKD-EPI-cr (p=0.004), MDRD (p=0.01), CG (p=0.037), CKD-EPI-cys (p=0.033), and CKD-EPI-cr-cys (p=0.016) eGFRs in the A2 group were significantly different from the A1 group. All eGFRs showed a moderate correlation with CrCl in the A1group (CKD-EPI-cr and CKD-EPI-cr-cys: r=0.49, p=0.0001, MDRD: r=0.44, p=0.001, CG r=0.48, p=0.0001: CKD-EPI-cys r=0.40, p=0.004). The area under the CKD-EPI-cys ROC curve was the highest and found to be 0.847 (95%CI 0.763-0.931, p=0.0001).

Conclusions: Our results showed that the CKD-EPI-cys eGFR can be useful in detecting the early stage of DN and more predictive than the others for prediction of DN.

Citing Articles

CYSTATIN C-A Monitoring Perspective of Chronic Kidney Disease in Patients with Diabetes.

Visinescu A, Rusu E, Cosoreanu A, Radulian G Int J Mol Sci. 2024; 25(15).

PMID: 39125705 PMC: 11311327. DOI: 10.3390/ijms25158135.

Diagnostic value of triglyceride and cystatin C ratio in diabetic kidney disease: a retrospective and prospective cohort study based on renal biopsy.

Wei J, Wang B, Shen F, Zhang T, Duan Z, Zhou D BMC Nephrol. 2022; 23(1):270.

PMID: 35896961 PMC: 9327235. DOI: 10.1186/s12882-022-02888-3.

References

Drion I, Joosten H, Groenier K, Lieverse A, Kleefstra N, Wetzels J . Equations estimating renal function in patients with diabetes. Neth J Med. 2011; 69(10):455-60. View

Jeon Y, Kim M, Huh J, Mok J, Song S, Kim S . Cystatin C as an early biomarker of nephropathy in patients with type 2 diabetes. J Korean Med Sci. 2011; 26(2):258-63. PMC: 3031011. DOI: 10.3346/jkms.2011.26.2.258. View

Dai S, Yasuda Y, Zhang C, Horio M, Zuo L, Wang H . Evaluation of GFR measurement method as an explanation for differences among GFR estimation equations. Am J Kidney Dis. 2011; 58(3):496-8. DOI: 10.1053/j.ajkd.2011.05.016. View

Kar S, Paglialunga S, Islam R . Cystatin C Is a More Reliable Biomarker for Determining eGFR to Support Drug Development Studies. J Clin Pharmacol. 2018; 58(10):1239-1247. DOI: 10.1002/jcph.1132. View

Du Bois D, Du Bois E . A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989; 5(5):303-11; discussion 312-3. View

Tuttle K, Bakris G, Bilous R, Chiang J, de Boer I, Goldstein-Fuchs J . Diabetic kidney disease: a report from an ADA Consensus Conference. Diabetes Care. 2014; 37(10):2864-83. PMC: 4170131. DOI: 10.2337/dc14-1296. View

Perrone R, Madias N, Levey A . Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem. 1992; 38(10):1933-53. View

Molitch M, Steffes M, Sun W, Rutledge B, Cleary P, de Boer I . Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study. Diabetes Care. 2010; 33(7):1536-43. PMC: 2890355. DOI: 10.2337/dc09-1098. View

Dharnidharka V, Kwon C, Stevens G . Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002; 40(2):221-6. DOI: 10.1053/ajkd.2002.34487. View

10.

. Standards of medical care in diabetes--2014. Diabetes Care. 2013; 37 Suppl 1:S14-80. DOI: 10.2337/dc14-S014. View

11.

. 6. Glycemic Targets: . Diabetes Care. 2017; 41(Suppl 1):S55-S64. DOI: 10.2337/dc18-S006. View

12.

Bevc S, Hojs R, Ekart R, Zavrsnik M, Gorenjak M, Puklavec L . Simple cystatin C formula for estimation of glomerular filtration rate in overweight patients with diabetes mellitus type 2 and chronic kidney disease. Exp Diabetes Res. 2012; 2012:179849. PMC: 3447360. DOI: 10.1155/2012/179849. View

13.

Jin R, Grunkemeier G, Brown J, Furnary A . Estimated glomerular filtration rate and renal function. Ann Thorac Surg. 2008; 86(1):1-3. DOI: 10.1016/j.athoracsur.2008.05.007. View

14.

Gaspari F, Perico N, Remuzzi G . Application of newer clearance techniques for the determination of glomerular filtration rate. Curr Opin Nephrol Hypertens. 1998; 7(6):675-80. DOI: 10.1097/00041552-199811000-00009. View

15.

Mussap M, Dalla Vestra M, Fioretto P, Saller A, Varagnolo M, Nosadini R . Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int. 2002; 61(4):1453-61. DOI: 10.1046/j.1523-1755.2002.00253.x. View

16.

Cheuiche A, Queiroz M, Azeredo-da-Silva A, Silveiro S . Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis. Sci Rep. 2019; 9(1):1418. PMC: 6363744. DOI: 10.1038/s41598-018-38286-9. View

17.

Simetic L, Zibar L, Drmic S, Begic I, Seric V . Creatinine Clearance and Estimated Glomerular Filtration Rate--When are they Interchangeable. Coll Antropol. 2016; 39(3):735-43. View

18.

Oh S, Lee J, Ha W, Jeong S, Yim H, Son H . Comparison of cystatin C- and creatinine-based estimation of glomerular filtration rate according to glycaemic status in Type 2 diabetes. Diabet Med. 2012; 29(7):e121-5. DOI: 10.1111/j.1464-5491.2012.03628.x. View

19.

Rognant N, Lemoine S, Laville M, Hadj-Aissa A, Dubourg L . Performance of the chronic kidney disease epidemiology collaboration equation to estimate glomerular filtration rate in diabetic patients. Diabetes Care. 2011; 34(6):1320-2. PMC: 3114318. DOI: 10.2337/dc11-0203. View

20.

Iliadis F, Didangelos T, Ntemka A, Makedou A, Moralidis E, Gotzamani-Psarakou A . Glomerular filtration rate estimation in patients with type 2 diabetes: creatinine- or cystatin C-based equations?. Diabetologia. 2011; 54(12):2987-94. DOI: 10.1007/s00125-011-2307-1. View