Effects of dose and type of corticosteroids on the divergence between estimated glomerular filtration rates derived from cystatin C and creatinine

Abstract

Summary What is known and objective Cystatin C (Cys‐C) is a useful diagnostic marker for early renal dysfunction, but has the disadvantage of giving false‐positive results when corticosteroids are administered. In this study, we aimed to evaluate the dose‐dependent effect of corticosteroids on the divergence between estimated glomerular filtration rates based on Cys‐C (eGFRcys) and creatinine (eGFRcreat) and calculate the cut‐off value of corticosteroid dose having an impact on eGFRcys/eGFRcreat ratio. Methods This retrospective study included 305 patients (1318 therapies) treated with oral or injectable corticosteroids between June 2014 and May 2018, who did not meet the exclusion criteria. All corticosteroid doses were converted to prednisolone equivalent. Results Steroid dose correlated significantly with eGFRcys/eGFRcreat ratio for all corticosteroids and for prednisolone (rs = −.150 and −.273, respectively), whereas no correlation was observed for methylprednisolone and hydrocortisone. The cut‐off value of prednisolone dose for eGFRcys/eGFRcreat ratio < 0.79 was 0.170 mg/kg/day, with 62.4% sensitivity and 84.7% specificity. The correlation coefficient (rs = −.434) between prednisolone dose and eGFRcys/eGFRcreat ratio for doses of 0.170 mg/kg/day and higher was markedly larger compared with all corticosteroids. What is new and conclusion These findings suggest that results should be interpreted with caution when using eGFRcys as renal function marker in patients treated with prednisolone at doses of 0.170 mg/kg/day and higher.

Divergence between serum creatine and cystatin C in estimating glomerular filtration rate of critically ill COVID-19 patients

“…In critically ill group, a total of 56 (73.7 %) patients died in hospital. The median time from illness onset and ICU admission to death was 29 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) days and 9 (5-18) days, respectively (Table 2). Compared with survivors, non-survivors had higher levels of APACHEII, SOFA scores, D-dimer category and inflammatory markers, including WBC, IL-6, IL-8 and hsCRP (Table 3 The units of sCr and CysC were umol/L and mg/L, respectively.…”

“…Some studies [10,[16][17][18] considered sCr highly misleading in ICU patients because of muscle mass loss and volume overload in many critically ill patients. CysC is also influenced by several factors such as age [19,20], corticosteroids administrations [21][22][23], inflammation [19,24], and diabetes status [25,26]. So far, little is known about the performance of sCr and CysC for glomerular filtration rate (GFR) estimation in critically ill patients with COVID-19.…”

Utility of a Score for Predicting Glomerular Filtration Rate Overestimation in Patients with Cardiovascular and Renal Diseases and Their Risk Factors

“…1a ). Since active inflammation, thyroid dysfunction, and steroid therapy have been shown to modulate the serum cystatin C concentration in a GFR-independent manner ( 4 , 11 - 14 ), patients with a C-reactive protein level of >1 mg/dL, those with hyperthyroidism/hypothyroidism, and those receiving corticosteroids were excluded. Patients <20 years old, those with an eGFRcre of <15 mL/min/1.73 m 2 or with acute kidney injury (AKI), and those with missing data were also excluded.…”

Comparison of Creatinine and Cystatin C to Estimate Renal Function in Geriatric and Frail Patients

“…Cystatin C is an alternative endogenous protein used to estimate renal function (eGFR cys ). It is a protease inhibitor produced by all nucleated cells and is not affected by muscle mass [1,2], but may be affected by other factors including hypo-and hyperthyroidism (falsely decreased and falsely elevated, respectively) [1,2] and high-dose steroid therapy (falsely elevated) [1,11]. In Sweden, Cystatin C is approximately seven times more expensive to analyze compared to creatinine.…”