Comparison of the diagnostic value of symmetric dimethylarginine, cystatin C, and creatinine for detection of decreased glomerular filtration rate in dogs

Abstract

Background Early detection of decreased glomerular filtration rate (GFR) in dogs is challenging. Current methods are insensitive and new biomarkers are required. Objective To compare overall diagnostic performance of serum symmetric dimethylarginine (SDMA) and serum cystatin C to serum creatinine, for detection of decreased GFR in clinically stable dogs, with or without chronic kidney disease (CKD). Animals Ninety‐seven client‐owned dogs: 67 dogs with a diagnosis or suspicion of CKD and 30 healthy dogs were prospectively included. Methods Prospective diagnostic accuracy study. All dogs underwent physical examination, systemic arterial blood pressure measurement, urinalysis, hematology and blood biochemistry analysis, cardiac and urinary ultrasound examinations, and scintigraphy for estimation of glomerular filtration rate (mGFR). Frozen serum was used for batch analysis of SDMA and cystatin C. Results The area under the curve of creatinine, SDMA, and cystatin C for detection of an mGFR <30.8 mL/min/L was 0.98 (95% confidence interval [CI], 0.93‐1.0), 0.96 (95% CI, 0.91‐0.99), and 0.87 (95% CI, 0.79‐0.93), respectively. The sensitivity of both creatinine and SDMA at their prespecified cutoffs (115 μmol/L [1.3 mg/dL] and 14 μg/dL) for detection of an abnormal mGFR was 90%. The specificity was 90% for creatinine and 87% for SDMA. When adjusting the cutoff for cystatin C to correspond to a diagnostic sensitivity of 90% (0.49 mg/L), specificity was lower (72%) than that of creatinine and SDMA. Conclusions and Clinical Importance Overall diagnostic performance of creatinine and SDMA for detection of decreased mGFR was similar. Overall diagnostic performance of cystatin C was inferior to both creatinine and SDMA.

Biomarkers for chronic kidney disease in dogs: a comparison study

“…Whereas showed that CysC was higher sensitivity and specificity compared to other factors. CREA and SDMA are insufficient for detecting IRIS stage I in the previous study [16] and also the present study, while serum levels of the biomarker CysC are showed increased in IRIS stage I in the present study. To the best of our knowledge, the present study was assessed that CysC levels in dogs with CKD to determine its efficacy for detecting early stage CKD compared to that of CREA and SDMA.…”

“…Similarly, a study on humans reported a comparison of eGFR equations of CREA, SDMA, and CysC and their application as markers of kidney function [17]. Several veterinary studies also reported that the levels of kidney biomarkers CREA, SDMA, and CysC were higher in dogs with CKD than in healthy dogs [2,9,11], however, the results were not the same as those reported by Pelander et al for CysC [16]. It has reported that CysC is not a superior biomarkers than others, whereas the present study has showed that CysC is a beneficial biomarker for detecting IRIS stage I compared to CREA or SDMA.…”

Serum cystatin C concentration can be used to evaluate glomerular filtration rate in small dogs

“…This may relate to the fact that there is a very large range of physical size among different dog breeds, much more so that is typically detected among healthy human subjects. Previous studies suggested that serum CysC concentration was not superior to serum Cre in its utility for the detection of decreased GFR in dogs [3,29]. One explanation for this finding might be the effect of body weight on serum CysC concentrations.…”

“…In veterinary medicine, several studies have also shown that serum CysC concentrations in dogs are a better marker for GFR than Cre concentrations [22,33]. Recently, Pelander et al [29] demonstrated that serum CysC concentrations were less reliable than Cre or SDMA for the detection of decreased GFR in dogs. However, it is possible that using serum CysC levels to detect decreased GFR in dogs will need to consider differences in levels secondary to body weight.…”

Ihr Spürsinn ist gefragt – Renale Biomarker zur Diagnostik von Nierenerkrankungen

“…Trotz der geringeren extrarenalen Beeinflussung im Vergleich zu Kreatinin und der früheren Detektion einer Nierenerkrankung scheint die Messung von SDMA nicht bei jedem Patienten einen diagnostischen Mehrwert zu bringen [14]. Sinnvoll ist die Bestimmung bei Patienten, bei denen infolge der Bemuskelung eine erschwerte Interpretation der Kreatininkonzentration zu erwarten ist (▶ Abb.…”