Utility of estimated glomerular filtration rate using cystatin C and its interpretation in patients with rheumatoid arthritis under glucocorticoid therapy

Nozawa, Yoshinori; Sato, Hiroki; Wakamatsu, Ayako; Kobayashi, Daisuke; Nakatsue, Takeshi; Wada, Yoko; Kuroda, Takeshi; Kazama, Junichiro James; Suzuki, Yuichi; Nakano, Masaaki; Narita, Ichiei

doi:10.1016/j.cca.2018.10.022

Cited by 16 publications

(14 citation statements)

References 18 publications

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“…Cimerman et al 13 reported elevation of not only Scyc but also Scr by corticosteroid administration, whereas Risch et al 22 observed no change in Scr level by high‐dose corticosteroids. Moreover, Nozawa et al 23 found no correlation between corticosteroid dose and eGFRcreat. Taken the above into consideration, the decreased eGFRcys/eGFRcreat ratio that depends on corticosteroid dose is unlikely to be due to an increase in eGFRcreat and would likely be caused by a decrease in eGFRcys.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 97%

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

et al. 2020

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“…Nozawa et al (28) noted that eGFR-CysC appeared to be lower when ≥ 10 mg/day prednisolone was administered, while not being affected by < 10 mg. In our study, Group A used prednisolone ≤ Relationship between eGFR-Cr and eGFR-CysC eGFR-Cr; estimated glomerular filtration rate using creatinine eGFR-CysC; estimated glomerular filtration rate using cystatin C The correlation between eGFR-Cr and eGFR-CysC was significant (r=0.715, p<0.0001).…”

Section: Discussionmentioning

confidence: 99%

Factors contributing to discrepant estimated glomerular filtration values measured by creatinine and cystatin C in patients with rheumatoid arthritis

Kawano

Nakashima

Horita

et al. 2020

Preprint

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Background This study aimed to clarify the factors underlying the discrepancy that has been noted between estimated glomerular filtration ratio (eGFR) measured using serum creatinine (Cr) and eGFR using serum cystatin C (CysC) in patients with rheumatoid arthritis (RA) and to identify those patients whose renal function should be evaluated using CysC.Methods We retrospectively evaluated clinical features, disease activity, radiological grading, and co-morbidities (diabetes mellitus, hypertension, dyslipidemia) in 238 RA patients. eGFR using serum creatinine (eGFR-Cr) and eGFR using serum cystatin C (eGFR-CysC) were calculated using the new Japanese coefficient-modified Modification of Diet in Renal Disease study equation. To clarify the cause(s) of differences of 20% or more between the two eGFRs, we divided our RA patients into Group A (eGFR-Cr/eGFR-CysC ≥ 1.2), with eGFR-Cr more than 20% higher than eGFR-CysC, and Group B (eGFR-Cr/eGFR-CysC < 1.2), and compared various clinical parameters between them.Results Forty-five patients (18.9%) were assigned to Group A, and 193 (81.1%) to Group B. Group A were older (73.8 ± 12.5 vs 63.2 ± 13.6 years), and had a longer disease duration (17.7 ± 14.0 vs 10.4 ± 9.5 years), lower body mass index (BMI) (20.0 ± 2.9 vs 22.4 ± 3.6 kg/m2), higher frequencies of hypertension and diabetes mellitus (55.6% vs 30.1% and 35.6% vs 11.0%, respectively), higher DAS28-ESR (3.1 ± 1.3 vs 2.6 ± 1.0), lower hemoglobin (Hb) (11.8 ± 1.8 vs 12.8 ± 1.4 g/dl), lower creatine kinase (CK) (63.9 ± 36.0 vs 92 ± 79 IU/L), higher frequency of Steinbrocker stage 4 (46.7% vs. 15.3%), and a lower frequency of nonsteroidal anti-inflammatory drugs (NSAID) use (13.3% vs 30.6%), all significantly (p < 0.01) by a univariate analysis. BMI (Odds Ratio [OR] 0.820, 95% confidence interval [CI] 0.675–0.996), Hb (OR 0.633, 95% CI 0.433–0.926), CK (OR 0.773 per 10 units, 95% CI 0.644–0.933), NSAID use (OR 0.099, 95% CI 0.020–0.494), diabetes mellitus (OR 6.024, 95% CI 1.508–24.390) and stage 4 Steinbrocker radiological grade (OR 10.309, 95% CI 2.994–35.714) were identified as independent relevant factors for Group A by a multifactorial analysis.Conclusion Renal function in RA patients with low BMI, diabetes, anemia and low CK may be overestimated using eGFR-Cr alone, and such patients need to be evaluated using eGFR-CysC.

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“…However, they enrolled some patients with systemic lupus erythematosus, systemic vasculitis, or Goodpasture syndrome who may take glucocorticoids for a long time. Glucocorticoids may affect serum cystatin C levels 27,28 . We excluded patients who took glucocorticoids from the present study, as well as patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Relationship between serum cystatin C and prognosis of nondiabetic peritoneal dialysis patients

et al. 2020

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We investigated whether serum cystatin C predicted treatment failure and mortality in nondiabetic peritoneal dialysis (PD) patients. We studied 163 new‐onset, nondiabetic PD patients between January 2010 and January 2019. Patients were followed up until death or 1 July 2019. Serum cystatin C was measured within 1 week before PD. Basic demographic and laboratory test data were collected. Patients were divided into low (<5.54 mg/L) and high (≥5.54 mg/L) serum cystatin C groups. The Kaplan‐Meier method and log‐rank test showed that the technical survival rate of the low cystatin C group was higher than that of the high cystatin C group. There was no difference in overall survival between the two groups. Multivariate Cox model showed that serum cystatin C was an independent risk factor for PD failure. Serum cystatin C could predict PD failure but was not associated with mortality in nondiabetic PD patients.

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Utility of estimated glomerular filtration rate using cystatin C and its interpretation in patients with rheumatoid arthritis under glucocorticoid therapy

Cited by 16 publications

References 18 publications

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

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

Factors contributing to discrepant estimated glomerular filtration values measured by creatinine and cystatin C in patients with rheumatoid arthritis

Relationship between serum cystatin C and prognosis of nondiabetic peritoneal dialysis patients

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