Performance of serum cystatin C versus serum creatinine as a marker of glomerular filtration rate as measured by inulin renal clearance
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Serum cystatin C was recently proposed as an alternative marker of glomerular filtration rate (GFR), with a suggested better performance than creatinine. However, detailed studies are limited. We evaluated the performance of cystatin C as a GFR marker.
GFR was measured by inulin clearance in 763 Japanese subjects. Factors other than GFR influencing serum cystatin C or serum creatinine were analyzed by multivariate analyses.
After adjustment for GFR, the value of serum creatinine was 25.2% lower in females than males, and decreased by 5.2% for every 20 years of age. Serum cystatin C was 8.2% lower in females, and did not change significantly with aging. Creatinine but not cystatin C was significantly affected by body weight, height and body mass index after adjustment for GFR, gender and age. The correlation coefficient between GFR and 1/cystatin C was significantly higher than that of 1/creatinine in total subjects (0.866 and 0.810, respectively, p < 0.001). Unlike serum creatinine, serum cystatin C did not increase in association with the reduction of GFR in subjects with very low GFR. The regression line of 1/cystatin C against GFR showed a significantly negative intercept of about −8 ml/min/1.73 m2.
The performance of serum cystatin C was not good in the subjects with very low GFR. Non-renal elimination of cystatin C may contribute to the result. The correlation between reciprocal cystatin C and GFR suggested its superiority in predicting GFR compared to creatinine in subjects with normal and mildly reduced GFR.
- Levey AS, Perrone RD, Madias NE. Serum creatinine and renal function. Annu Rev Med. 1988;39:465–90. CrossRef
- Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002;40:221–6. CrossRef
- Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, on behalf of the collaborators developing the Japanese equation for estimating GFR, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92. CrossRef
- Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S. Modification of the CKD epidemiology collaboration (CKD-EPI) equation for Japanese: accuracy and use for population estimates. Am J Kidney Dis. 2010;56:32–8. CrossRef
- Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int. 2009;75:652–60. CrossRef
- Knight EL, Verhave JC, Spiegelman D, Hillege HL, Zeeuw DD, Curhan GC, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65:1416–21. CrossRef
- Sjostrom PA, Tidman MA, Jones IL. Determination of the production rate and non-renal clearance of cystatin C and estimation of the glomerular filtration rate from the serum concentration of cystatin C in humans. Scand J Clin Lab Invest. 2005;65:111–24. CrossRef
- Sjostrom PA, Jones IL, Tidman MA. Cystatin C as a filtration marker—haemodialysis patients expose its strengths and limitations. Scand J Clin Lab Invest. 2009;69:65–72. CrossRef
- Tenstad O, Roald AB, Grubb A, Aukland K. Renal handling of radiolabelled human cystatin C in the rat. Scand J Clin Lab Invest. 1996;56:409–14. CrossRef
- Eriksen BO, Mathisen UD, Melsom T, Ingebretsen OC, Jenssen TG, Njolstad I, et al. Cystatin C is not a better estimator of GFR than plasma creatinine in the general population. Kidney Int. 2010;78:1305–11. CrossRef
- Levinson S. Calibration of the Siemens cystatin C immunoassay has changed over time. Clin Chem. 2011;57:777–8. CrossRef
- Voskoboev NV, Larson TS, Rule AD, Lieske C. Importance of cystatin C assay standardization. Clin Chem. 2011;57:1209–11. CrossRef
- Grubb A, Blirup-Jensen S, Lindstrom V, Schmidt C, Althaus H, Zegers I. First certified reference material for cystatin C in human serum ERM-DA471/IFCC. Clin Chem Lab Med. 2010;48:1619–21. CrossRef
- Kotajima N, Yanagawa Y, Aoki T, Tsunekawa K, Morimura T, Ogiwara T, et al. Influence of thyroid hormones and transforming growth factor-β1 on cystatin C concentrations. J Int Med Res. 2010;38:1365–73.
- Fricker M, Wiesli P, Brandle M, Schwegler B, Schmid C. Impact of thyroid dysfunction on serum cystatin C. Kidney Int. 2003;63:1944–7. CrossRef
- Rule AD, Bergstralh EJ, Slezak JM, Bergert J, Larson TS. Glomerular filtration rate estimated by cystatin C among different clinical presentations. Kidney Int. 2006;69:399–405. CrossRef
- Performance of serum cystatin C versus serum creatinine as a marker of glomerular filtration rate as measured by inulin renal clearance
Clinical and Experimental Nephrology
Volume 15, Issue 6 , pp 868-876
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Cystatin C
- Inulin clearance
- Glomerular filtration rate
- Industry Sectors
- Author Affiliations
- 1. Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
- 2. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- 3. Third Department of Medicine, Fukushima Medical University, Fukushima, Japan