The search for a new marker of renal function in older patients with chronic kidney disease stages 3-4: Usefulness of cystatin C-based equations

Néstor Fontseré, Vicens Esteve, Ana Saurina, Mónica Pou, Nuria Barba, Ramón Deulofeu, Silvana Di Gregorio, Luis Miguel Del Rio, Jose Rios, Ferran Torres, Franscesc Maduell, Josep M. Campistol, Manel Ramírez De Arellano

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8 Citations (Scopus)

Abstract

Background/Aim: Cystatin C (Cys C) is an endogenous marker of glomerular filtration rate (GFR) unaffected by body composition. The aim of the present study was to assess the utility of Cys C-based GFR prediction equations (Hoek, Larsson and Stevens) and creatinine (modification of diet in renal disease-isotope dilution mass spectrometry - MDRD-IDMS, and Cockcroft-Gault - CG) compared with 51Cr-EDTA. Methods: This study was carried out in 40 Caucasian older patients with advanced age (≥60) and chronic kidney disease stages 3-4. To assess the utility of prediction equations in relation to body composition, we measured lean mass (LM) with densitometry (DXA). Pearson's, Bland-Altman and Lin's coefficient (Rc) were used to study accuracy and precision. Results:51Cr-EDTA was 36.9 ± 9.2 ml/min/1.73 m2 (22-60). Cys C levels were 2.2 ± 0.8 mg/l (r = 0.085; p = 0.662 LM) and creatinine 2.8 ± 1.1 mg/dl (r = 0.427; p = 0.021 LM). The most accurate equations were the Hoek, Larsson and Stevens formulae, with a bias of -0.2 (Rc 0.48), -2.9 (Rc 0.44) and 2.6 ml/min/1.73 m2 (Rc 0.58). The biases obtained with MDRD-IDMS and CG were -14.6 (Rc 0.35) and -12.5 (Rc 0.40). All correlations among biases obtained with creatinine-based formulae and LM were negative and statistically significant (p < 0.05). Conclusions: The results show superiority of Cys C-based GFR formulae over the MDRD-IDMS and CG equations. This significant underestimation obtained with conventional prediction equations was directly related to the influence of LM. © 2009 S. Karger AG, Basel.
Original languageEnglish
JournalNephron - Clinical Practice
Volume112
Issue number3
DOIs
Publication statusPublished - 1 Jun 2009

Keywords

  • Advanced age
  • Chronic kidney disease stages 3-4
  • Conventional prediction equations
  • Cystatin C
  • Glomerular filtration rate

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