Cystatin C as a marker of glomerular filtration rate

Inker, Lesley A.; Okparavero, Aghogho

doi:10.1097/mnh.0b013e32834b8850

Cited by 63 publications

(43 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…31 Additionally, it has been shown to be affected by demographic factors, diabetes status, white blood cell count, albumin and C-reactive protein levels independent of GFR. 32 Yet, in the general population, cystatin C has been shown to correlate with mGFR more strongly than creatinine. 33,34 Furthermore, eGFR calculated using cystatin C has been shown to have stronger associations with cardiovascular disease, all-cause mortality, and ESRD when compared with eGFR calculated using creatinine.…”

Section: Cystatin C Based Estimates Of Gfrmentioning

confidence: 99%

GFR Estimating Equations and Liver Disease

Beben

Rifkin

2015

Advances in Chronic Kidney Disease

View full text Add to dashboard Cite

It is important to accurately assess the glomerular filtration rate (GFR) of patients with liver disease in order to deliver care and allocate organs for transplantation in a way that improves outcomes. The most commonly used methods to estimate GFR in this population are based on creatinine, which is biased by these patients’ low creatinine production and potentially by elevated serum bilirubin and decreased albumin levels. None of the creatinine based estimated GFR (eGFR) equations have been specifically modified for a population with liver disease, and even measurement of a 24 hour creatinine clearance has limitations. In liver disease, all creatinine based estimates of GFR overestimate gold standard measured GFR (mGFR), and the degree of overestimation is highest at lower mGFR values and in more severe liver disease. Cystatin C based eGFR has shown promise in general population studies by demonstrating less bias than creatinine based eGFR and improved association with clinically important outcomes, but results in the liver disease population have been mixed and further studies are necessary. Ultimately, specific eGFR equations for liver disease or novel methods for estimating GFR may be necessary. However, for now, the limitations of currently available methods need to be appreciated to understand renal function in liver disease.

show abstract

Section: Cystatin C Based Estimates Of Gfrmentioning

confidence: 99%

GFR Estimating Equations and Liver Disease

Beben

Rifkin

2015

Advances in Chronic Kidney Disease

View full text Add to dashboard Cite

show abstract

“…Epidemiological studies have found that eGFR measurements based on cystatin C (eGFRcys) show a stronger association with renal and CVD outcomes than GFR estimated according to the creatinine level (eGFRcre) [1,2]. Because there is little evidence indicating that cystatin C is more effective for estimating GFR compared to creatinine, this superior risk prediction by eGFRcys may be caused by the confounding of non-GFR determinants of cystatin C and creatinine [3,4]. Several studies have shown eGFR to be influenced by traditional CVD risk factors independently of the measured GFR (mGFR).…”

Section: Introductionmentioning

confidence: 99%

Estimated GFR Is Biased by Non-Traditional Cardiovascular Risk Factors

Melsom¹,

Fuskevåg²,

Mathisen³

et al. 2015

Am J Nephrol

View full text Add to dashboard Cite

Background: Estimated glomerular filtration rate (eGFR) based on either cystatin C or creatinine performs similarly in estimating measured GFR, but associate differently with cardiovascular disease (CVD) and mortality. This could be due to confounding by non-GFR-related traits associated with cystatin C and creatinine levels. We investigated non-GFR-related associations between eGFR and two types of nontraditional risk factors for CVD and death: L-arginine/dimethylarginine metabolism and insulin resistance. Methods: GFR was measured via iohexol clearance in a cross-sectional study of 1,624 middle-aged persons from the general population without CVD, diabetes or chronic kidney disease. The dimethylarginines were measured using liquid chromatography tandem mass spectrometry (LC-MSMS). Insulin resistance was determined by the homeostasis model assessment (HOMA-IR). Results: Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), the L-arginine/ADMA ratio and insulin resistance were associated with creatinine-based eGFR after accounting for measured GFR in multivariable adjusted analyses. The cystatin C-based eGFR showed a similar residual association with SDMA; an oppositely directed, borderline significant association with ADMA; and a stronger residual association with insulin resistance compared with eGFR based on creatinine. Conclusion: Both creatinine- and cystatin C-based eGFR are influenced by nontraditional risk factors, which may bias risk prediction by eGFR in longitudinal studies.

show abstract

“…However, until recently, the lack of a common standard resulted in large differences among assays [10,[54][55][56].…”

Section: Cystatin C Assaysmentioning

confidence: 99%

“…Their use is recommended in nephrology [1] and radiology guidelines [2][3][4][5], and in contrast medium textbooks [6] to identify patients at risk of CIAKI or nephrogenic systemic fibrosis [7]. The last decade has seen an increased interest in cystatin C to supplement creatinine in new equations to estimate GFR [8][9][10]. Unfortunately, issues of calibration of creatinine and cystatin C assays with regard to selection of GFR equation are generally not discussed in CIAKI studies or given enough consideration in guidelines or textbooks.…”

Section: Introductionmentioning

confidence: 99%