, Volume 15, Issue 6, pp 868-876
Date: 24 Aug 2011

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.

On behalf of the collaborators for developing Japanese equation for estimating GFR.