Comparison of estimated glomerular filtration rate values calculated using serum cystatin C and serum creatinine

Abstract

Objective: In this study, we aimed to compare estimated glomerular filtration rate (eGFR) formulas based on cystatin C and serum creatinine and investigate whether the formulas can detect the renal damage at microalbuminuric level in diabetic patients.

Methods: Totally, 99 type 2 diabetic patients were included and divided into 3 groups according to 24 hour urine albumin levels as normoalbuminuric group (group 1), microalbuminuric group (group 2) and macroalbuminuric group (group 3). Creatinine clearance, Cockcroft-Gault (C-G), Modification of Diet in Renal Disease (MDRD), The Chronic Kidney Disease Epidemiology (CKD-EPI), eGFR1, eGFR2 and eGFR3 levels were calculated using formulas.

Results: There were significant differences between group 1-3 and group 2-3, but there was no significant difference between group 1 and 2 in calculated GFR levels. Cystatin C-based formulas were found to have a better correlation with creatinine clearance.

Conclusion: As a result, cystatin C-based formulas were found to predict creatinine clearance better than the other calculated GFR formulas in diabetic patients. However none of the formulas can discriminate the renal damage at microalbuminuric level. J Clin Exp Invest 2015; 6 (2): 91-95

Key words: eGFR, cystatin C, diabetic nephropathy, creatinine, CKD-EPI

Keywords

• eGFR, cystatin C, diabetic nephropathy, creatinine, CKD-EPI

Serum sistatin C ve serum kreatinin kullanılarak hesaplanan tahmini glomerüler filtrasyon hızı değerlerinin karşılaştırılması

Öz

Amaç: Bu çalışmada sistatin C ve/veya serum kreatinin kullanılarak hesaplanan tahmini glomerüler filtrasyon hızı (eGFR) formüllerini karşılaştırma ve bunların diyabetli hastalarda mikroalbuminürik düzeydeki hasarı tespit edip edemeyeceğinin araştırılması amaçlanmıştır.Yöntemler: Çalışmaya tip 2 DM tanısı olan toplam 99 hasta dahil edilmiştir. Hastalar 24 saatlik idrar albumin miktarına göre normoalbuminürik (grup 1), mikroalbuminürik (grup 2), makroalbuminürik (grup 3) olarak üç gruba ayrılmıştır. Kreatinin klirensi ile Cockcroft-Gault (C-G), MDRD (Modification of Diet in Renal Disease) ve CKD-EPI (The Chronic Kidney Disease Epidemiology), eGFR1, eGFR2, eGFR3 düzeyleri formüllerle hesaplanmıştır.Bulgular: GFR değerlerinde Grup 1-3 ve Grup 2-3 arasında anlamlı farklılık gözlenirken, Grup 1 ile Grup 2 arasında anlamlı fark gözlenmedi. Sistatin C içeren eGFR formüllerinin diğer formüllere göre kreatinin klirensi ile daha anlamlı bir korelasyon gösterdiği bulundu.Sonuç: Diabetik hastaların takibinde Sistatin C bazlı formüllerin kullanımının, hesaplamada sistatin C kullanmayan diğer formüllere göre kreatinin klirens tahmininde daha iyi olduğu bulunmuştur. Ancak hiçbir formül böbrekteki mikroalbuminürik düzeydeki hasarı tespit edememiştir

Anahtar Kelimeler

• eGFR, sistatin C, diabetik nefropati, kreatinin, CKD-EPI

References

1. Jeon YK, Kim MR, Huh JE, et al. Cystatin C as an early
2. biomarker of nephropathy in patients with type 2 diabetes. J Korean Med Sci 2011;26:258-263.
3. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for
4. Diabetes Care 2004;27:1047-1053.
5. Ritz E, Orth SR. Nephropathy in patients with type 2 diabetes mellitus. N Engl J Med 1999;341:1127-1133.
6. Goldberg TH, Finkelstein MS. Difficulties in estimating
7. glomerular filtration rate in the elderly. Arch Intern Med 1987;147:1430-1433.
8. Feng JF, Qiu L, Zhang L, et al. Multicenter Study of Creatinine-and / or Cystatin C-Based Equations for Estimation

9. of Glomerular Filtration Rates in Chinese Patients with
10. Chronic Kidney Disease. PLoS One 2013;8:e57240.
11. Miller WG. Estimating glomerular filtration rate. Clin Chem
12. Lab Med 2009;47:1017-1019.
13. Levey AS, Bosch JP, Lewis JB, et al. A more accurate
14. method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-470.
15. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612.
16. Teo BW, Ng ZY, Li J, et al. The choice of estimating equations for glomerular filtration rate significantly affects the prevalence of chronic kidney disease in a multi-ethnic population during health screening. Nephrology (Carlton) 2009;14:588-596.
17. Teo BW, Xu H, Wang D, et al. Estimating glomerular
18. filtration rates by use of both cystatin C and standardized serum creatinine avoids ethnicity coefficients in Asian patients with chronic kidney disease. Clin Chem 2012;58:450-457.
19. Grubb A, Nyman U, Bjork J. Improved estimation of glomerular filtration rate ( GFR ) by comparison of eGFR
20. cystatin C and eGFR creatinine. Scand J Clin Lab Invest.
21. ;72:73-77.
22. Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem
23. ;48:699-707.
24. Coll E, Botey A, Alvarez L, et al. Serum cystatin C as
25. a new marker for noninvasive estimation of glomerular
26. filtration rate and as a marker for early renal impairment.
27. Am J Kidney Dis 2000;36:29-34.
28. Levey AS, Greene T, Schluchter MD, et al. Glomerular
29. filtration rate measurements in clinical trials. Modification
30. of Diet in Renal Disease Study Group and the Diabetes Control and Complications Trial Research Group. J Am Soc Nephrol 1993;4:1159-1171.
31. Karawajczyk M, Ramklint M, Larsson A. Reduced cystatin C-estimated GFR and increased creatinine-estimated GFR in comparison with iohexol-estimated GFR in a hyperthyroid patient: a case report. J Med Case Rep. 2008;2:66.
32. Stevens LA, Coresh J, Schmid CH, et al. Estimating GFR
33. using serum cystatin C alone and in combination with
34. serum creatinine: a pooled analysis of 3,418 individuals
35. with CKD. Am J Kidney Dis 2008;51:395-406.
36. Bevc S, Hojs R, Ekart R, et al. Simple cystatin C formula
37. for estimation of glomerular filtration rate in overweight
38. patients with diabetes mellitus type 2 and chronic kidney
39. disease. Exp Diabetes Res 2012;2012:179849.
40. Du X, Liu L, Hu B, et al. Is the Chronic Kidney Disease
41. Epidemiology Collaboration four-level race equation better than the cystatin C equation? Nephrology (Carlton) 2012;17:407-414.
42. Marwyne MN, Loo CY, Halim AG, et al. Estimation of
43. glomerular filtration rate using serum cystatin C in overweight and obese subjects. Med J Malaysia 2011;66:313-317.
44. Camargo EG, Soares AA, Detanico AB, et al. The Chronic Kidney Disease Epidemiology Collaboration ( CKD-EPI ) equation is less accurate in patients with Type 2 diabetes when compared with healthy individuals. Diabet Med 2011;28:90-95.
45. Inker LA, Eckfeldt J, Levey AS, et al. Expressing the
46. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) cystatin C equations for estimating GFR with
47. standardized serum cystatin C values. Am J Kidney Dis 2011;58:682-684