Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis

Abstract

The accuracy of estimated glomerular filtration rate (eGFR) equations in diabetes mellitus (DM) patients has been extensively questioned. We evaluated the performance of cystatin C-based equations alone or in combination with creatinine to estimate GFR in DM patients. A PRISMA-compliant systematic review was performed in the MEDLINE and Embase databases, with “diabetes mellitus” and “cystatin C” as search terms. Studies comparing cystatin C-based eGFR equations with measured GFR (mGFR) in DM patients were eligible. Accuracies P10, P15, P20, and P30 indicated the proportion of eGFR results within 10, 15, 20, and 30% of mGFR. Single-arm meta-analyses were conducted, and the Quality of Diagnostic Accuracy Studies-II tool (QUADAS-2) was applied. Twenty-three studies comprising 7065 participants were included, and 24 equations were analyzed in a broad range of GFRs. Meta-analyses were completed for 10 equations. The mean P30 accuracies of the equations ranged from 41% to 87%, with the highest values found with both CKD-EPI equations. Mean P10-P15 achieved 35% in the best scenario. A sensitivity analysis to evaluate different mGFR methods did not change results. In conclusion, cystatin C-based eGFR equations represent measured GFR fairly at best in DM patients, with high variability among the several proposed equations.

Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project

“…As suggested in other studies, in patients with diabetes, the use of a cystatin C-based CKD definition offered better clinical utility for risk prediction than creatinine-based equations [ 8 ]. In addition, a systematic review including 23 studies came to the conclusion that cystatin C-based eGFR represents measured GFR well in patients with diabetes [ 9 ]. The observation in our spline plots that higher creatinine-based eGFR again showed an adverse association with the outcomes has been shown previously [ 7 , 42 ].…”

“…Meanwhile, it has been demonstrated that the addition of a cystatin C-based equation improves overall risk classification for death, cardiovascular disease, and end-stage renal disease [ 7 ]. However, different equations, based on creatinine or cystatin C measurements, for estimating CKD seem to have different performance characteristics in high-risk and low-risk populations and subgroups such as older adults or patients with diabetes [ 8 , 9 ]. An analysis of the clinical value in specific populations (e.g., for risk prediction) such as high-risk and low-risk CVD populations, older adults, or patients with diabetes would further help to assess the performance of the various estimated glomerular filtration rate (eGFR) estimation equations.…”

Association between Endothelial Dysfunction, Biomarkers of Renal Function, and Disease Severity in Sickle Cell Disease

“…Our study did not demonstrate any relationship between serum creatinine, a biomarker of renal function, and FMD. The discordance in the relationship between Cys-C and creatinine with FMD, relating to glomerular filtration, may be because, although Cys-C is freely filtered by the glomerular membrane, it is neither reabsorbed nor secreted in the kidney tubular system, unlike creatinine (38). Similarly, no relationship was noted between eGFR and FMD.…”

Giá trị lâm sàng của Cystatin C huyết thanh trong dự đoán mức lọc cầu thận ở bệnh nhân đái tháo đường típ 2

“…Mặc dù các công thức này đơn giản, ít tốn kém, dễ thực hiện, nhưng các công thức trên không ước tính GFR một cách chính xác ở những đối tượng ĐTĐT2. Các công thức ước tính GFR dựa vào creatinine không phải là một công thức tốt trong dự đoán rối loạn chức năng thận giai đoạn sớm ở ĐTĐT2 khi so sánh với GFR ước tính dựa vào cystatin C huyết thanh [5], [7], [17], [18].…”