Association between serum Cystatin C and renal injury in patients with chronic hepatitis B

Abstract

To explore the association between serum cystatin C (Cys-C) and renal damage in patients with chronic hepatitis B. We retrospectively analyzed the clinical data of 425 patients with chronic hepatitis B virus (HBV) infection. Liver stiffness measured by FibroScan was used to diagnosis liver fibrosis. Cys-C levels were detected via latex-enhanced immunoturbidimetric assay. A total of 425 patients were enrolled. Among them, 217 were patients with CHB with an eGFR > 90 mL/min/1.73 m 2 and 208 with an eGFR ≤90 mL/min/1.73 m 2 . Cys-C levels significantly differed in patients with eGFR > 90 mL/min/1.73 m 2 compared with patients with eGFR ≤90 mL/min/1.73 m 2 (0.81 ± 0.05 vs 1.05 ± 0.06 mg/L, P < .001). Moreover, the Cys-C levels were 0.82 ± 0.04 mg/L in patients without liver fibrosis, 0.98 ± 0.05 mg/L in patients with mild liver fibrosis, 1.05 ± 0.08 mg/L in patients with advanced liver fibrosis, and 1.12 ± 0.07 mg/L in patients with liver cirrhosis ( P < .001). Multivariate analyses were conducted to explore the independent factors associated with a decreased eGFR. Multivariate analysis suggested that T2DM ( P = .032), liver fibrosis ( P = .013), and Cys-C level ( P = .035) were the independent factors associated with the decreased eGFR in patients with CHB. While age ( P = .020) and Cys-C level ( P = .001) were the independent factors associated with the decreased eGFR in patients with CHB-related fibrosis. The fibrosis group had significantly higher Cys-C levels than those without fibrosis. Routine monitoring of Cys-C levels is of positive significance in preventing the development of renal impairment of CHB patients.

Serum cystatin C is an early renal dysfunction biomarker in patients with hepatitis C virus

“…HCV-infected patients had significantly higher serum cystatin C (> 1.24 mg/L) and lower creatinine/cystatin C ratio (< 70.1 μMol/mg) and was correlated with renal function and extrahepatic cryoglobulins and RF and complement C3 parameters. This finding may be supported by many studies that reported the relationship between HCV infection and serum cystatin C [ 8 – 10 ]. The creatinine/cystatin C ratio or creatinine/cystatin C × 100 was an indicator to sarcopenia index (SI) for the prediction of liver injury and sarcopenia in liver disease [ 22 ] and monitoring the progression of non-alcoholic fatty liver disease [ 21 ].…”

“…HCV may induce chronic liver fibrosis and kidney injury or hepatorenal syndrome through either direct viral invasion of the renal parenchyma [ 25 , 26 ], glomerular immune complex deposition, renal complications of its extrarenal hepatic manifestations [ 27 ], or nephrotoxicity of drugs used for its treatment [ 3 , 4 ]. Serum cystatin C level was an indirect marker of liver fibrosis in several chronic liver diseases [ 8 , 28 ].…”

“…Moreover, cystatin C has a shorter half-life [ 47 ] and provided an early prediction of kidney dysfunction in coronary heart diseases in spite of a normal serum creatinine level [ 48 ]. Serum cystatin C is increased with the progression of chronic viral hepatitis C as a potential marker for liver inflammation and fibrosis [ 8 , 9 , 28 ].…”

“…Therefore, serum cystatin C could provide an alternative method to creatinine-based criteria for eGFR [ 12 , 13 ]. Moreover, serum cystatin C has some advantages over the serum creatinine as a biomarker for eGFR [ 5 ], and it is elevated in early hepatic fibrosis [ 8 ] rather than early kidney disease [ 12 ].…”

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“…Villa et al [ 136 ] observed that serum CysC is a better marker of GFR than creatinine in unstable patients with acute renal failure. Zheng et al [ 137 ] studying a group of 425 patients with chronic hepatitis B found that cystatin C may be an essential indicator of developing renal functional impairment in these patients. The concentration of this protein is also a good factor for diagnosing AKI, rising before changes in creatinine [ 138 ].…”