Glomerular filtration rate estimation using cystatin C alone or combined with creatinine as a confirmatory test

Li Fan, Lesley A. Inker, Jerome Rossert, Marc Froissart, Peter Rossing, Michael Mauer, Andrew S. Levey

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71 Scopus citations


Background. Glomerular filtration rate (GFR) estimating equations using the combination of creatinine and cystatin C (eGFRcr-cys) are more accurate than equations using either alone (eGFRcr or eGFRcys). New guidelines suggest measuring cystatin C as a confirmatory test when eGFRcr may be inaccurate, but do not specify demographic or clinical conditions in which eGFRcys or eGFRcr-cys are more accurate than eGFRcr nor which estimate to use in such circumstances. Methods. We compared the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in 1119 subjects in the CKD-EPI cystatin C external validation dataset. Subgroups were defined by eGFRcr, age, sex, diabetes status and body mass index (BMI). The reference test was GFR measured using urinary or plasma clearance of exogenous filtration markers. Cystatin C and creatinine assays were traceable to primary reference materials. Accuracy was defined as the absolute difference in eGFR compared with mGFR. Results. The mean mGFR was 70 ± 41 (SD) mL/min/1.73 m2. eGFRcys was more accurate than eGFRcr at lower BMI and less accurate at higher BMI, especially at higher levels of eGFRcr. There were small differences in accuracy in people according to the diabetes status. eGFRcr-cys was as accurate or more accurate than eGFRcr or eGFRcys in these and all other subgroups. Conclusions. eGFRcr-cys, but not eGFRcys, is more accurate than eGFRcr in most subgroups we studied, suggesting preferential use of eGFRcr-cys when serum cystatin C is measured as a confirmatory test to obtain more accurate eGFR. Further studies are necessary to evaluate diagnostic strategies for using eGFRcys and eGFRcr-cys.

Original languageEnglish (US)
Pages (from-to)1195-1203
Number of pages9
JournalNephrology Dialysis Transplantation
Issue number6
StatePublished - Jun 2014

Bibliographical note

Funding Information:
The NephroTest CKD cohort study is supported by the following grants: INSERM GIS-IReSP AO 8113LS TGIR, French Ministry of Health AOM 09114 and 10, Agence de la Biomé-decine R0 8156LL, Roche 2009-152-447G and AURA.


  • cystatin C
  • diagnostic test accuracy
  • estimated GFR


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