Title: Does cystatin C improve prediction of glomerular filtration rate? Validation in routine use
Abstract: Background Clinical guidelines recommend reporting estimated glomerular filtration rate (eGFR) based on plasma creatinine to predict kidney function. This study aimed to assess whether inclusion of cystatin C could improve accuracy of prediction equations in comparison to a gold standard in cancer patients and a healthy normal group. Methods Plasma creatinine and cystatin C was analysed in 155 patients (cancer, n = 80; kidney donors, n=75) undergoing Tech-netium-DTPA GFR procedure. The performance of three equations by the CKD-EPI group (creatinine-, creatinine and cystatin C-, cystatin C-based) was compared to Tc-DTPA GFR. Results Overall, the combination of creatinine and cystatin C equation had the smallest GFR underestimation of -5.7 mL/min/ 1.73 m2 (95%CI -8.9 to -2.4). Diagnostic sensitivity and specificity was highest for this equation in the overall population (AUC = 0.855, p < 0.05), however the proportion of results for all equations within 30% of GFR was not different for the overall population, nor in subgroup analyses. Conclusion: The inclusion of cystatin C together with creatinine in prediction equations marginally improved the prediction of GFR in the overall population and in males. More research is required to improve the accuracy of prediction equations in cancer patients for guiding therapy. Clinical guidelines recommend reporting estimated glomerular filtration rate (eGFR) based on plasma creatinine to predict kidney function. This study aimed to assess whether inclusion of cystatin C could improve accuracy of prediction equations in comparison to a gold standard in cancer patients and a healthy normal group. Plasma creatinine and cystatin C was analysed in 155 patients (cancer, n = 80; kidney donors, n=75) undergoing Tech-netium-DTPA GFR procedure. The performance of three equations by the CKD-EPI group (creatinine-, creatinine and cystatin C-, cystatin C-based) was compared to Tc-DTPA GFR. Overall, the combination of creatinine and cystatin C equation had the smallest GFR underestimation of -5.7 mL/min/ 1.73 m2 (95%CI -8.9 to -2.4). Diagnostic sensitivity and specificity was highest for this equation in the overall population (AUC = 0.855, p < 0.05), however the proportion of results for all equations within 30% of GFR was not different for the overall population, nor in subgroup analyses. Conclusion: The inclusion of cystatin C together with creatinine in prediction equations marginally improved the prediction of GFR in the overall population and in males. More research is required to improve the accuracy of prediction equations in cancer patients for guiding therapy.
Publication Year: 2014
Publication Date: 2014-01-01
Language: en
Type: article
Indexed In: ['crossref']
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