Comparison between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate in the Follow-Up of Patients Recovering from a Stage-3 AKI in ICU

Abstract

Background: Acute kidney injury (AKI) in critically ill patients is associated with a significant increase in mortality as well as long-term renal dysfunction and chronic kidney disease (CKD). Serum creatinine (SCr), the most widely used biomarker to evaluate kidney function, does not always accurately predict the glomerular filtration rate (GFR), since it is affected by some non-GFR determinants such as muscle mass and recent meat ingestion. Researchers and clinicians have gained interest in cystatin C (CysC), another biomarker of kidney function. The study objective was to compare GFR estimation using SCr and CysC in detecting CKD over a 1-year follow-up after an AKI stage-3 event in the ICU, as well as to analyze the association between eGFR (using SCr and CysC) and mortality after the AKI event. Method: This prospective observational study used the medical records of ICU patients diagnosed with AKI stage 3. SCr and CysC were measured twice during the ICU stay and four times following diagnosis of AKI. The eGFR was calculated using the EKFC equation for SCr and FAS equation for CysC in order to check the prevalence of CKD (defined as eGFR < 60 mL/min/1.73 m2). Results: The study enrolled 101 patients, 36.6% of whom were female, with a median age of 74 years (30–92), and a median length of stay of 14.5 days in intensive care. A significant difference was observed in the estimation of GFR when comparing formulas based on SCrand CysC, resulting in large differences in the prediction of CKD. Three months after the AKI event, eGFRCysC < 25 mL/min/1.73 m2 was a predictive factor of mortality later on; however, this was not the case for eGFRSCr. Conclusion: The incidence of CKD was highly discrepant with eGFRCysC versus eGFRSCr during the follow-up period. CysC detects more CKD events compared to SCr in the follow-up phase and eGFRCysC is a predictor for mortality in follow-up but not eGFRSCr. Determining the proper marker to estimate GFR in the post-ICU period in AKI stage-3 populations needs further study to improve risk stratification.

The Good, the Bad, and the Serum Creatinine: Exploring the Effect of Muscle Mass and Nutrition

“…Particularly, studies reported that CysC-based prediction equations were more precise and could benefit the earlier detection of renal impairment in specific subpopulations. In patients with reduced muscle mass because of amputations or in those with degenerative muscle disease, also in both children and obese patients, CysC might assess renal function [72, 73].…”

Cystatin C or creatinine for pre-operative assessment of kidney function and risk of post-operative acute kidney injury: a secondary analysis of the METS cohort study

“…Cystatin C has been shown to predict all-cause mortality and cardiovascular morbidity in a range of clinical settings including the general population [ 16 ], the elderly [ 17 ], and individuals with acute and chronic cardiovascular disease [ 18–20 ]. After critical illness which is near universally accompanied by profound muscle wasting, cystatin C provides a more accurate measure of kidney function [ 21 ] and is more strongly associated with ongoing risk of death [ 22 , 23 ]. However, cystatin C has not been extensively explored as a pre-operative predictor of AKI and other adverse outcomes after major surgery, despite many major-surgical candidates having low muscle mass.…”