Combined creatinine-cystatin C CKD-EPI equation significantly underestimates measured glomerular filtration rate in people with type 2 diabetes mellitus

Machado, Julia Dauernheimer; Camargo, Eduardo Guimarães; Boff, Roberta; Rodrigues, Laís da Silva; Camargo, Joíza Lins; Soares, Ariana Aguiar; Silveiro, Sandra Pinho

doi:10.1016/j.clinbiochem.2018.01.005

Cited by 13 publications

(21 citation statements)

References 27 publications

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“…A large European multicenter study concluded that, overall, the addition of cystatin C improved precision of the combined equations compared with their creatinine equation counterparts 52 . However, once more in the diabetes scenario, cystatin C-based equations do not seem to outperform creatinine equations 26,53 .…”

Section: Discussionmentioning

confidence: 96%

Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis

Cheuiche

Queiroz

Azeredo-da-Silva

et al. 2019

Sci Rep

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The accuracy of estimated glomerular filtration rate (eGFR) equations in diabetes mellitus (DM) patients has been extensively questioned. We evaluated the performance of cystatin C-based equations alone or in combination with creatinine to estimate GFR in DM patients. A PRISMA-compliant systematic review was performed in the MEDLINE and Embase databases, with “diabetes mellitus” and “cystatin C” as search terms. Studies comparing cystatin C-based eGFR equations with measured GFR (mGFR) in DM patients were eligible. Accuracies P10, P15, P20, and P30 indicated the proportion of eGFR results within 10, 15, 20, and 30% of mGFR. Single-arm meta-analyses were conducted, and the Quality of Diagnostic Accuracy Studies-II tool (QUADAS-2) was applied. Twenty-three studies comprising 7065 participants were included, and 24 equations were analyzed in a broad range of GFRs. Meta-analyses were completed for 10 equations. The mean P30 accuracies of the equations ranged from 41% to 87%, with the highest values found with both CKD-EPI equations. Mean P10-P15 achieved 35% in the best scenario. A sensitivity analysis to evaluate different mGFR methods did not change results. In conclusion, cystatin C-based eGFR equations represent measured GFR fairly at best in DM patients, with high variability among the several proposed equations.

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Section: Discussionmentioning

confidence: 96%

Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis

Cheuiche

Queiroz

Azeredo-da-Silva

et al. 2019

Sci Rep

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“…We included studies that: (a) compared the accuracy of the CKD-EPI equation to sGFR in DM and non-DM subjects simultaneously, (b) used sGFR, including measurement of inulin, iohexol, 99m Tc-DTPA or 51 Cr-EDTA clearance, (c) provided accuracy P30 information, and (d) recruited patients > 18 years of age. Six studies 21 – 23 , 25 , 31 , 32 of 1660 DM and 1517 non-DM patients simultaneously reported accuracy P30 using the CKD-EPI equation. Table 2 shows the characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…A later study reported worse performance of the CKD-EPI equation in diabetic compared with non-diabetic subjects. 31 Another study also showed that the GFR, as estimated using the CKD-EPI and MDRD equations in diabetic patients, was estimated less accurately than in normal control subjects. 38 Guidelines suggest that the accuracy P30 should exceed 90%, but studies rarely achieve this value.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations in diabetic patients: a systematic review and meta-analysis

2020

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Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations are common for calculating estimated glomerular filtration rate (eGFR). Unlike CKD, the key pathological change of diabetic kidney disease (DKD) is glomerulosclerosis. Methods To conduct a meta-analysis of the diagnostic performance of the CKD-EPI and MDRD equations in diabetic patients, we searched PubMed, Embase and the Cochrane Library for studies comparing standard GFR (sGFR) with eGFR using these two equations. Results Thirteen studies of 7192 diabetic patients reporting data on bias or accuracy were included. At the study level, both equations underestimated eGFR. CKD-EPI was more accurate in studies with mean GFR ≥60 mL/minute/1.73 m2. At the individual level, both equations overestimated GFR by 6.38 mL/minute/1.73 m2 (95% confidence interval [CI] 2.67–10.1) and 7.65 mL/minute/1.73 m2 (95% CI 2.78–12.52), respectively, for sGFR < 90 mL/minute/1.73 m2. The CKD-EPI equation was 7.61% (95% CI 4.66–10.56) more accurate in subjects with sGFR > 90 mL/minute/1.73 m2. The CKD-EPI equation performed poorly in diabetic patients. Conclusions The CKD-EPI equation can be used to estimate GFR in patients with incipient DKD, but has drawbacks. Improved eGFR equations suitable for diabetic populations are needed.

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“…In addition, several workers have reported that elevated CystC is related to left ventricular concentric hypertrophy and increased left ventricular volume in CHF patients. Therefore, CgA and CystC may be used to assess the severity of chronic heart failure [12,13].…”

Section: Discussionmentioning

confidence: 99%

Effect of serum cystatin C and chromogranin A on left ventricular mass index in patients with chronic heart failure

Xue¹,

Liu²

2019

Trop. J. Pharm Res

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Purpose: To investigate the expression of serum cystatin C (CystC) and chromogranin A (CgA) in chronic heart failure (CHF) patients, and their correlation with left ventricular mass index (LVMI). Methods: CHF patients (135) in the study hospital were randomly selected, and assigned to different groups on the basis of heart function grade (grades II to IV). Grades II, III and IV had 45 patients each. In addition, 45 people with normal physical examination results were assigned to the control group. In all patients, N-terminal natriuretic peptide (NT-proBNP), CysC and CgA were measured. In addition, left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured using transthoracic echocardiography, and the results were used to calculate LVMI values. Results: There were significantly higher levels of CystC and CgA in CHF patients than in control patients (p < 0. 05). In grade IV patients, CystC and CgA levels were higher than the corresponding levels in patients with cardiac function grades II and III, while their levels in grade III patients were higher than in grade II patients (p < 0.05). The results of correlation analysis indicated that serum CgA was positively correlated with serum CystC. Serum CgA and CystC levels in CHF patients were negatively correlated with LVEF, but positively correlated with NT-proBNP and LVMI levels. Conclusion: Serum CgA and CysC are correlated with cardiac function grade and ventricular remodeling in CHF patients. Thus, to some extent, these two indices can be used to measure the degree of ventricular remodeling in CHF individuals.

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Combined creatinine-cystatin C CKD-EPI equation significantly underestimates measured glomerular filtration rate in people with type 2 diabetes mellitus

Cited by 13 publications

References 27 publications

Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis

Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis

Diagnostic value of the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations in diabetic patients: a systematic review and meta-analysis

Effect of serum cystatin C and chromogranin A on left ventricular mass index in patients with chronic heart failure

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