The value of serum cystatin C in early evaluation of renal insufficiency in patients undergoing chemotherapy: a systematic review and meta-analysis
Several studies have shown that cystatin C levels can be used to detect decline in renal function in cancer patients receiving chemotherapy, and can serve as a supplement to creatinine level measurement for early detection of renal insufficiency. Nevertheless, use of the parameter remains controversial. This study aimed to assess the value of serum cystatin C levels in evaluation of early renal insufficiency due to chemotherapy.
Studies were retrieved from PubMed, Ovid Embase, the Web of Science, the Cochrane Library, Ovid, and the CNKI databases up to May 15, 2018. Serum levels of cystatin C before and after chemotherapy were evaluated for its ability to assess renal function.
A total of 12 studies, including 1775 participants, met our inclusion and exclusion criteria. Pooled analysis revealed that the levels of serum cystatin C in cancer patients after chemotherapy were significantly higher than those of patients prior to treatment [standard mean difference (SMD) = 0.54, 95% CI 0.34–0.74, P = 0.0000]. Compared to creatinine, serum cystatin C increased significantly in the early phases of glomerular filtration rate (GFR) change before and after chemotherapy (GFR ≥ 90 ml/min/1.73 m2, P < 0.05 vs. P > 0.05, 5.83%; 60 < GFR < 90 ml/min/1.73 m2, P < 0.01 vs. P > 0.01, 38.83%) and increased more substantially in the later phases (GFR < 60 ml/min/1.73 m2, P < 0.01 vs. P < 0.01, 70.87% vs. 23.09%). However, creatinine decreased even in the early phases and did not increase in an obvious manner until the later phases (GFR < 60 ml/min/1.73 m2, P < 0.01, 23.09%). The GFR values were derived from measured methods.
Cystatin C may be superior to creatinine for the detection of minor changes in GFR in early stages of renal insufficiency secondary to chemotherapy. More studies are needed to further verify this result.
KeywordsCystatin C Renal insufficiency Chemotherapy Meta-analysis
Thanks are due to investigators, surgeons and patients who participated in this study. We would like to thank the native English speaking scientists of Elixigen Company (Huntington Beach, California) for editing our manuscript.
This work was funded by National Natural Science Foundation of China (NSFC, Grant number 81560345).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was not required for this study.
- 18.Cavalcanti E, Barchiesi V, Cerasuolo D et al (2016) Correlation of serum cystatin C with glomerular filtration rate in patients receiving platinum-based chemotherapy. Anal Cell Pathol (Amst) 2016:4918325Google Scholar
- 22.Amirrasooli H, Tabatabaeefar M, Moeani B (2015) The efficacy of serum cystatin C and creatinine to diagnose impaired renal function in cancer patients under treatment with cisplatin. Int J Hematol Oncol 27(1):51–59Google Scholar
- 25.Qin L, Kong F (2013) Analysis of the value of serum cystatin C for monitoring early renal damage in lung cancer chemotherapy. Chin J Cancer Prev Control 20(16):1267–1269Google Scholar
- 26.Wang B, Guo X, Gao Y (2013) The combined detection of serum cystatin C urinary beta 2 microglobulin and urine microalbumin in the early renal impairment of patients with malignant tumor. Anhui Med J 34(12):1840–1843Google Scholar
- 27.Zhao H, Xu X, Hu j, Qu H (2012) The value of serum cystatin C in monitoring renal dysfunction in patients with cisplatin chemotherapy. Guangdong Med 20:3136–3137Google Scholar
- 29.Jin C, Liu G, Dong Y (2010) Study on the clinical application of cystatin C in combined tumor chemotherapy. Modern Prev Med 37(20):3953–3955Google Scholar
- 38.Salek T, Vesely P, Bernatek J (2015) Estimated glomerular filtration rate in oncology patients before cisplatin chemotherapy. Klin Onkol Cas Ceské Slov Onkol Spolecnosti 28:273–277Google Scholar