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New standardized cystatin C and creatinine GFR equations in children validated with inulin clearance

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Abstract

Background

This study compares glomerular filtration rate (GFR) equations in children based on standardized cystatin C (CYSC) and creatinine (CREA) and their combinations with renal clearance of inulin (C-inulin).

Methods

A total of 220 children with different renal disorders were referred for C-inulin (median 84 ml/min/1.73 m2). Bias, precision (interquartile range, IQR), and accuracy (percentage of estimates ±30 % of C-inulin; P30) were evaluated for two cystatin C equations, CAPACYSC and BergCYSC, for creatinine equations, SchwartzCREA and GaoCREA, the arithmetic mean of CAPACYSC and SchwartzCREA (MEANCAPA+Schwartz), BergCYSC and SchwartzCREA (MEANBERG+SCHWARTZ) and the composite equation ChehadeCYSC+CREA.

Results

Overall results of CAPACYSC, BergCYSC, SchwartzCREA, GaoCREA, MEANCAPA+Schwartz, MEANBERG+SCHWARTZ and ChehadeCYSC+CREA were: median bias –7.6/–4.9/–3.7/–2.3/–4.6/–4.0/–10.1 %, IQR 20.0/19.9/21.7/22.4/21.0/20.9/23.3 ml/min/1.73 m2 and P30 86/86/80/83/89/91/83 %. The cystatin C equations, MEANCAPA+Schwartz and MEANBERG+SCHWARTZ had a more stable performance across subgroups compared with SchwartzCREA, GaoCREA and ChehadeCYSC+CREA.

Conclusions

Cystatin C was the preferred filtration marker for GFR estimation in children, while the benefit of combining cystatin C and creatinine deserves further investigations.

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Authors and Affiliations

  1. Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden

    Ulla B. Berg, Kajsa Åsling Monemi & Maria Herthelius

  2. Institution of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden

    Ulf Nyman

  3. Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden

    Rune Bäck & Magnus Hansson

  4. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden

    Jonas Björk

Authors
  1. Ulla B. Berg
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  2. Ulf Nyman
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  3. Rune Bäck
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  4. Magnus Hansson
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  5. Kajsa Åsling Monemi
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  6. Maria Herthelius
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  7. Jonas Björk
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Corresponding author

Correspondence to Ulla B. Berg.

Additional information

Rune Bäck has passed away during the study.

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Berg, U.B., Nyman, U., Bäck, R. et al. New standardized cystatin C and creatinine GFR equations in children validated with inulin clearance. Pediatr Nephrol 30, 1317–1326 (2015). https://doi.org/10.1007/s00467-015-3060-3

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  • DOI: https://doi.org/10.1007/s00467-015-3060-3

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