Cystatin c enhances glomerular filtration rate estimating equations in kidney transplant recipients

Aleksandra Kukla, Naim S Issa, Scott Jackson, Richard S Spong, Meredith C. Foster, Arthur J Matas, Michael Mauer, John H Eckfeldt, Hassan N Ibrahim

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The glomerular filtration rate (GFR) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR. Whether this equation performs well in kidney transplant recipients cross-sectionally, and more importantly, over time has not been addressed. Methods: We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial (NCT 00067990): Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine (eGFR (CKD-EPI-Creat+CysC)), cystatin C alone (eGFR (CKD-EPI-CysC)), creatinine alone (eGFR (CKD-EPI-Creat)) and the Modification of Diet in Renal Disease study equation (eGFR (MDRD)). Iothalamate GFR served as a standard (mGFR). Results: mGFR, serum creatinine, and cystatin C shortly after transplant were 56.1 ± 17.0 ml/min/1.73 m2, 1.2 ± 0.4 mg/dl, and 1.2 ± 0.3 mg/l respectively. eGFR (CKD-EPI-Creat+CysC) was most precise (R2 = 0.50) but slightly more biased than eGFR (MDRD); 9.0 ± 12.7 versus 6.4 ± 15.8 ml/min/1.73 m2, respectively. This improved precision was most evident in recipients with mGFR >60 ml/min/1.73 m2. For relative accuracy, eGFR (MDRD) and eGFR (CKD-EPI-Creat+CysC) had the highest percentage of estimates falling within 30% of mGFR; 75.8 and 68.9%, respectively. Longitudinally, equations incorporating cystatin C most closely paralleled the change in mGFR. Conclusion: eGFR (CKD-EPI-Creat+CysC) is more precise and reflects GFR change over time reasonably well. eGFR (MDRD) had superior performance in recipients with mGFR between 30 and 60 ml/min/1.73 m2.

Original languageEnglish (US)
Pages (from-to)59-65
Number of pages7
JournalAmerican Journal of Nephrology
Volume39
Issue number1
DOIs
StatePublished - Feb 1 2014

Fingerprint

Cystatins
Cystatin C
Glomerular Filtration Rate
Creatinine
Kidney
Iothalamic Acid
Diet Therapy
Serum
Chronic Renal Insufficiency
Angiotensin II
Allografts
Transplant Recipients
Epidemiology
Transplants

Keywords

  • Chronic kidney disease epidemiology collaboration
  • Cystatin C
  • Glomerular filtration rate
  • Kidney transplantation
  • Modification of Diet in Renal Disease

Cite this

Cystatin c enhances glomerular filtration rate estimating equations in kidney transplant recipients. / Kukla, Aleksandra; Issa, Naim S; Jackson, Scott; Spong, Richard S; Foster, Meredith C.; Matas, Arthur J; Mauer, Michael; Eckfeldt, John H; Ibrahim, Hassan N.

In: American Journal of Nephrology, Vol. 39, No. 1, 01.02.2014, p. 59-65.

Research output: Contribution to journalArticle

Kukla, Aleksandra ; Issa, Naim S ; Jackson, Scott ; Spong, Richard S ; Foster, Meredith C. ; Matas, Arthur J ; Mauer, Michael ; Eckfeldt, John H ; Ibrahim, Hassan N. / Cystatin c enhances glomerular filtration rate estimating equations in kidney transplant recipients. In: American Journal of Nephrology. 2014 ; Vol. 39, No. 1. pp. 59-65.
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abstract = "Background: The glomerular filtration rate (GFR) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR. Whether this equation performs well in kidney transplant recipients cross-sectionally, and more importantly, over time has not been addressed. Methods: We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial (NCT 00067990): Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine (eGFR (CKD-EPI-Creat+CysC)), cystatin C alone (eGFR (CKD-EPI-CysC)), creatinine alone (eGFR (CKD-EPI-Creat)) and the Modification of Diet in Renal Disease study equation (eGFR (MDRD)). Iothalamate GFR served as a standard (mGFR). Results: mGFR, serum creatinine, and cystatin C shortly after transplant were 56.1 ± 17.0 ml/min/1.73 m2, 1.2 ± 0.4 mg/dl, and 1.2 ± 0.3 mg/l respectively. eGFR (CKD-EPI-Creat+CysC) was most precise (R2 = 0.50) but slightly more biased than eGFR (MDRD); 9.0 ± 12.7 versus 6.4 ± 15.8 ml/min/1.73 m2, respectively. This improved precision was most evident in recipients with mGFR >60 ml/min/1.73 m2. For relative accuracy, eGFR (MDRD) and eGFR (CKD-EPI-Creat+CysC) had the highest percentage of estimates falling within 30{\%} of mGFR; 75.8 and 68.9{\%}, respectively. Longitudinally, equations incorporating cystatin C most closely paralleled the change in mGFR. Conclusion: eGFR (CKD-EPI-Creat+CysC) is more precise and reflects GFR change over time reasonably well. eGFR (MDRD) had superior performance in recipients with mGFR between 30 and 60 ml/min/1.73 m2.",
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AU - Kukla, Aleksandra

AU - Issa, Naim S

AU - Jackson, Scott

AU - Spong, Richard S

AU - Foster, Meredith C.

AU - Matas, Arthur J

AU - Mauer, Michael

AU - Eckfeldt, John H

AU - Ibrahim, Hassan N

PY - 2014/2/1

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N2 - Background: The glomerular filtration rate (GFR) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR. Whether this equation performs well in kidney transplant recipients cross-sectionally, and more importantly, over time has not been addressed. Methods: We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial (NCT 00067990): Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine (eGFR (CKD-EPI-Creat+CysC)), cystatin C alone (eGFR (CKD-EPI-CysC)), creatinine alone (eGFR (CKD-EPI-Creat)) and the Modification of Diet in Renal Disease study equation (eGFR (MDRD)). Iothalamate GFR served as a standard (mGFR). Results: mGFR, serum creatinine, and cystatin C shortly after transplant were 56.1 ± 17.0 ml/min/1.73 m2, 1.2 ± 0.4 mg/dl, and 1.2 ± 0.3 mg/l respectively. eGFR (CKD-EPI-Creat+CysC) was most precise (R2 = 0.50) but slightly more biased than eGFR (MDRD); 9.0 ± 12.7 versus 6.4 ± 15.8 ml/min/1.73 m2, respectively. This improved precision was most evident in recipients with mGFR >60 ml/min/1.73 m2. For relative accuracy, eGFR (MDRD) and eGFR (CKD-EPI-Creat+CysC) had the highest percentage of estimates falling within 30% of mGFR; 75.8 and 68.9%, respectively. Longitudinally, equations incorporating cystatin C most closely paralleled the change in mGFR. Conclusion: eGFR (CKD-EPI-Creat+CysC) is more precise and reflects GFR change over time reasonably well. eGFR (MDRD) had superior performance in recipients with mGFR between 30 and 60 ml/min/1.73 m2.

AB - Background: The glomerular filtration rate (GFR) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR. Whether this equation performs well in kidney transplant recipients cross-sectionally, and more importantly, over time has not been addressed. Methods: We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial (NCT 00067990): Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine (eGFR (CKD-EPI-Creat+CysC)), cystatin C alone (eGFR (CKD-EPI-CysC)), creatinine alone (eGFR (CKD-EPI-Creat)) and the Modification of Diet in Renal Disease study equation (eGFR (MDRD)). Iothalamate GFR served as a standard (mGFR). Results: mGFR, serum creatinine, and cystatin C shortly after transplant were 56.1 ± 17.0 ml/min/1.73 m2, 1.2 ± 0.4 mg/dl, and 1.2 ± 0.3 mg/l respectively. eGFR (CKD-EPI-Creat+CysC) was most precise (R2 = 0.50) but slightly more biased than eGFR (MDRD); 9.0 ± 12.7 versus 6.4 ± 15.8 ml/min/1.73 m2, respectively. This improved precision was most evident in recipients with mGFR >60 ml/min/1.73 m2. For relative accuracy, eGFR (MDRD) and eGFR (CKD-EPI-Creat+CysC) had the highest percentage of estimates falling within 30% of mGFR; 75.8 and 68.9%, respectively. Longitudinally, equations incorporating cystatin C most closely paralleled the change in mGFR. Conclusion: eGFR (CKD-EPI-Creat+CysC) is more precise and reflects GFR change over time reasonably well. eGFR (MDRD) had superior performance in recipients with mGFR between 30 and 60 ml/min/1.73 m2.

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KW - Cystatin C

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