Creatinine versus cystatin C based glomerular filtration rate in critically ill patients

Ravn, Bo; Rimes-Stigare, Claire; Bell, Max; Hansson, Magnus; Hansson, Lars‐Olof; Martling, Claes‐Roland; Larsson, Anders; Mårtensson, Johan

doi:10.1016/j.jcrc.2019.04.007

Cited by 22 publications

(21 citation statements)

References 35 publications

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“…24 Nevertheless, if cystatin C is an outstanding kidney filtration biomarker in intensive care, one would expect a close relationship between gold standard measurements of GFR such as iohexol clearance. Rather, it has been shown that eGFR equations with both creatinine and cystatin C are more accurate than creatinine equations alone in the critically ill. 7 This has also been reported for other patient groups such as in CKD. 6 Could the added predictive value of cystatin C to long-term cardiovascular risk partly depend on other factors than true GFR?…”

Section: Cardiac Risk Factors and Preventionsupporting

confidence: 70%

Addition of cystatin C predicts cardiovascular death better than creatinine in intensive care

Helmersson‐Karlqvist

Lipcsey

Ärnlöv

et al. 2021

Heart

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ObjectiveDecreased kidney function increases cardiovascular risk and predicts poor survival. Estimated glomerular filtration rate (eGFR) by creatinine may theoretically be less accurate in the critically ill. This observational study compares long-term cardiovascular mortality risk by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation; Caucasian, Asian, paediatric and adult cohort (CAPA) cystatin C equation and the CKD-EPI combined creatinine/cystatin C equation.MethodsThe nationwide study includes 22 488 intensive care patients in Uppsala, Karolinska and Lund University Hospitals, Sweden, between 2004 and 2015. Creatinine and cystatin C were analysed with accredited methods at admission. Reclassification and model discrimination with C-statistics was used to compare creatinine and cystatin C for cardiovascular mortality prediction.ResultsDuring 5 years of follow-up, 2960 (13 %) of the patients died of cardiovascular causes. Reduced eGFR was significantly associated with cardiovascular death by all eGFR equations in Cox regression models. In each creatinine-based GFR category, 17%, 19% and 31% reclassified to a lower GFR category by cystatin C. These patients had significantly higher cardiovascular mortality risk, adjusted HR (95% CI), 1.55 (1.38 to 1.74), 1.76 (1.53 to 2.03) and 1.44 (1.11 to 1.86), respectively, compared with patients not reclassified. Harrell’s C-statistic for cardiovascular death for cystatin C, alone or combined with creatinine, was 0.73, significantly higher than for creatinine (0.71), p<0.001.ConclusionsA single cystatin C at admission to the intensive care unit added significant predictive value to creatinine for long-term cardiovascular death risk assessment. Cystatin C, alone or in combination with creatinine, should be used for estimating GFR for long-term risk prediction in critically ill.

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Section: Cardiac Risk Factors and Preventionsupporting

confidence: 70%

Addition of cystatin C predicts cardiovascular death better than creatinine in intensive care

Helmersson‐Karlqvist

Lipcsey

Ärnlöv

et al. 2021

Heart

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“…Several novel biomarkers have been shown to detect AKI earlier and are more sensitive than sCr (Table). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] For any prevention strategies to be effective, patients with high risk need to be identified before kidney insults result in kidney damage, and AKI needs to be diagnosed as early as possible. Downloaded From: https://jamanetwork.com/ on 10/31/2020 Damage markers indicate structural damage that may or may not be associated with reduced kidney function.…”

Section: Introductionmentioning

confidence: 99%

Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

et al. 2020

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IMPORTANCE In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. OBJECTIVE To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. EVIDENCE REVIEW At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. FINDINGS The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. CONCLUSIONS AND RELEVANCE Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.

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“…The use of hospital admission sCr as baseline level in patients in whom pre-admission sCr was missing might have resulted in an underestimation of the AKI incidence. Further, using sCr decline to define recovery from an AKI episode could in patients with muscle wasting during a prolonged ICU course lead to overestimation of renal function recovery [43]. However, we used eGFR calculations based on a combination of sCr and cystatin C at the time of RRI measurement and still observed a difference in estimated renal function between patients classified with or without AKI, suggesting any such misclassification was negligible.…”

Section: Discussionmentioning

confidence: 91%

Renal resistive index is associated with acute kidney injury in COVID-19 patients treated in the intensive care unit

et al. 2021

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Background Renal resistive index (RRI) is a promising tool for the assessment of acute kidney injury (AKI) in critically ill patients in general, but its role and association to AKI among patients with Coronavirus disease 2019 (COVID-19) is not known. Objective The aim of this study was to describe the pattern of RRI in relation to AKI in patients with COVID-19 treated in the intensive care unit. Methods In this observational cohort study, RRI was measured in COVID-19 patients in six intensive care units at two sites of a Swedish University Hospital. AKI was defined by the creatinine criteria in the Kidney Disease Improving Global Outcomes classification. We investigated the association between RRI and AKI diagnosis, different AKI stages and urine output. Results RRI was measured in 51 patients, of which 23 patients (45%) had AKI at the time of measurement. Median RRI in patients with AKI was 0.80 (IQR 0.71–0.85) compared to 0.72 (IQR 0.67–0.78) in patients without AKI (p = 0.004). Compared to patients without AKI, RRI was higher in patients with AKI stage 3 (median 0.83, IQR 0.71–0.85, p = 0.006) but not in patients with AKI stage 1 (median 0.76, IQR 0.71–0.83, p = 0.347) or AKI stage 2 (median 0.79, min/max 0.79/0.80, n = 2, p = 0.134). RRI was higher in patients with an ongoing AKI episode compared to patients who never developed AKI (median 0.72, IQR 0.69–0.78, p = 0.015) or patients who developed AKI but had recovered at the time of measurement (median 0.68, IQR 0.67–0.81, p = 0.021). Oliguric patients had higher RRI (median 0.84, IQR 0.83–0.85) compared to non-oliguric patients (median 0.74, IQR 0.69–0.81) (p = 0.009). After multivariable adjustment, RRI was independently associated with AKI (OR for 0.01 increments of RRI 1.22, 95% CI 1.07–1.41). Conclusions Critically ill COVID-19 patients with AKI have higher RRI compared to those without AKI, and elevated RRI may have a role in identifying severe and oliguric AKI at the bedside in these patients.

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Creatinine versus cystatin C based glomerular filtration rate in critically ill patients

Cited by 22 publications

References 35 publications

Addition of cystatin C predicts cardiovascular death better than creatinine in intensive care

Addition of cystatin C predicts cardiovascular death better than creatinine in intensive care

Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

Renal resistive index is associated with acute kidney injury in COVID-19 patients treated in the intensive care unit

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