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Discordance Between...
Discordance Between Creatinine-Based and Cystatin C–Based Estimated GFR : Interpretation According to Performance Compared to Measured GFR
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- Wang, Yeli (author)
- Harvard University
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- Adingwupu, Ogechi M. (author)
- Tufts Medical Center
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- Shlipak, Michael G. (author)
- San Francisco Veterans Administration Medical Center
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- Doria, Alessandro (author)
- Harvard Medical School
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- Estrella, Michelle M. (author)
- University of California, San Francisco
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- Froissart, Marc (author)
- Lausanne University Hospital
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Gudnason, Vilmundur (author)
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- Grubb, Anders (author)
- Lund University,Lunds universitet,Avdelningen för klinisk kemi och farmakologi,Institutionen för laboratoriemedicin,Medicinska fakulteten,Cystatin C, njursjukdom, amyloidos och antibiotika,Forskargrupper vid Lunds universitet,Division of Clinical Chemistry and Pharmacology,Department of Laboratory Medicine,Faculty of Medicine,Cystatin C, renal disease, amyloidosis and antibiotics,Lund University Research Groups
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- Kalil, Roberto (author)
- University of Maryland School of Medicine
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- Mauer, Michael (author)
- University of Minnesota
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- Rossing, Peter (author)
- University of Copenhagen
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- Seegmiller, Jesse (author)
- University of Minnesota
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- Coresh, Josef (author)
- Johns Hopkins Bloomberg School of Public Health
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- Levey, Andrew S. (author)
- Tufts Medical Center
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- Inker, Lesley A. (author)
- Tufts Medical Center
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(creator_code:org_t)
- 2023
- 2023
- English.
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In: Kidney Medicine. - 2590-0595. ; 5:10
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Abstract
Subject headings
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- Rationale & Objective: Use of cystatin C in addition to creatinine to estimate glomerular filtration rate (estimated glomerular filtration rate based on cystatin C [eGFRcys] and estimated glomerular filtration rate based on creatinine [eGFRcr], respectively) is increasing. When eGFRcr and eGFRcys are discordant, it is not known which is more accurate, leading to uncertainty in clinical decision making. Study Design: Cross-sectional analysis. Setting & Participants: Four thousand fifty participants with measured glomerular filtration rate (mGFR) from 12 studies in North America and Europe. Exposures: Serum creatinine and serum cystatin C. Outcome(s): Performance of creatinine-based and cystatin C–based glomerular filtration rate estimating equations compared to mGFR. Analytical Approach: We evaluated the accuracy of eGFRcr, eGFRcys, and the combination (eGFRcr-cys) compared to mGFR according to the magnitude of the difference between eGFRcr and eGFRcys (eGFRdiff). We used CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations to estimate glomerular filtration rate. eGFRdiff was defined as eGFRcys minus eGFRcr and categorized as less than −15, −15 to <15, and ≥15 mL/min/1.73 m2 (negative, concordant, and positive groups, respectively). We compared bias (median of mGFR minus eGFR) and the percentage of eGFR within 30% of mGFR. Results: Thirty percent of participants had discordant eGFRdiff (21.0% and 9.6% negative and positive eGFRdiffs, respectively). In the concordant eGFRdiff group, all equations displayed similar accuracy. In the negative eGFRdiff groups, eGFRcr had a large overestimation of mGFR (−13.4 [−14.5 to −12.2] mL/min/1.73 m2) and eGFRcys had a large underestimation (9.9 [9.1-11.2] mL/min/1.73m2), with opposite results in the positive eGFRdiff group. In both negative and positive eGFRdiff groups, eGFRcr-cys was more accurate than either eGFRcr or eGFRcys. These results were largely consistent across age, sex, race, and body mass index. Limitations: Few participants with major comorbid conditions. Conclusions: Discordant eGFRcr and eGFRcys are common. eGFR using the combination of creatinine and cystatin C provides the most accurate estimates among persons with discordant eGFRcr or eGFRcys.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
Keyword
- creatinine
- cystatin
- estimated GFR
- Glomerular filtration rate
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Wang, Yeli
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Adingwupu, Ogech ...
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Shlipak, Michael ...
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Doria, Alessandr ...
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Estrella, Michel ...
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Froissart, Marc
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show more...
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Gudnason, Vilmun ...
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Grubb, Anders
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Kalil, Roberto
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Mauer, Michael
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Rossing, Peter
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Seegmiller, Jess ...
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Coresh, Josef
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Levey, Andrew S.
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Inker, Lesley A.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Urology and Neph ...
- Articles in the publication
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Kidney Medicine
- By the university
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Lund University