To Compare performance of combined creatinine and cystatin C-based equation with equations based on either cystatin C or creatinine alone, in early chronic kidney disease.
Diagnostic accuracy study.
One hundred children with chronic kidney disease who underwent 99mTc diethylenetriamine pentaacetic acid (DTPA) glomerular filtration rate measurement.
Estimating equations for glomerular filtration rate (GFR) based on serum cystatin C alone and in combination with serum creatinine were generated using regression analyses. These equations and the creatinine-based equation [0.42 × height/creatinine] were validated in 42 children with glomerular filteration rate between 60 and 90 mL/min/1.73 m2. Bias, precision and accuracy of estimating equations using DTPA glomerular filteration rate as gold standard.
Cystatin C-based equation (GFR=96.9–30.4 x cystatin) overestimated while the combined cystatin C-and creatininebased equation [GFR=11.45 x (height/creatinine) 0.356 x (1/cystatin) 0.188] underestimated the measured GFR. Cystatin Cbased equation had less bias (1.9 vs. 12.4 ml/min/1.73 m2), and higher precision (13.1 vs. 25.6 mL/min/1.73 m2) and accuracy (92.1% vs. 75.7%) than creatinine-based equation. The combined cystatin C and creatinine equation had bias (−1.4 mL/ min/1.73 m2) precision (15.2 mL/min/1.73 m2) and accuracy (91.2%) similar to cystatin C-based equation.
Cystatin C-based equation has a better performance in estimating glomerular filtration rate than creatinine-based equation in children with early chronic kidney disease. Addition of creatinine equation does not improve the performance of the cystatin C-based equation.
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National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(Suppl 1):S1–266.
Hari P, Bagga A, Mahajan P, Lakshmy R. Effect of malnutrition on serum creatinine and cystatin C levels. Pediatr Nephrol. 2007;22:1757–1761.
Andersen TB, Eskild-Jensen A, Frokiaer J, Brochner-Mortensen J. Measuring glomerular filtration rate in children; can cystatin C replace established methods? Pediatr Nephrol. 2009;24:929–941.
Filler G, Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol. 2003;18:981–985.
Grubb A, Nyman U, Bjork J, Lindstrom V, Rippe B, Sterner G, et al. A simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem. 2005;51:1420–1431.
Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C a new marker of glomerular filtration rate in children independent of age and height. Pediatrics. 1998;101:875–881.
Bouvet Y, Bouissou F, Coulais Y, Seronie-Vivien S, Tafani M, Decramer S, et al. GFR is better estimated by considering both serum cystatin C and creatinine levels. Pediatr Nephrol. 2006;21:1299–1306.
Du Bois D, Du Bois EF. Clinical calorimetry and formula to estimate the appropriate surface area if height and weight be known. Arch Int Med. 1916;17:863.
Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Sixt R, et al. Guidelines for glomerular filtration rate determination in children. Eur J Nucl Med. 2001;28:31–36.
Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, et al. Serum cystatin C as measured by automated immunoassay, a more sensitive marker for changes in GFR than serum creatinine. Kidney Int. 1995;47:312–318.
Romeo J. Evaluation of a kinetic method for creatinine. Lab Med. 1975;6:15–18.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.
WHO AnthroPlus for personal computers Manual. Software for Assessing Growth of the World’s Children and Adolescents. Geneva: WHO, 2009 (http://www.who.int/growthref/tools/en/).
Hari P, Biswas B, Pandey R, Kalaivani M, Kumar R, Bagga A. Updated height- and creatinine-based equation and its validation for estimation of glomerular filtration rate in children from developing countries. Clin Exp Nephrol. 2012;16:697–705.
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20:629–637.
Zappitelli M, Parvex P, Joseph L, Paradis G, Grey V, Lau S, et al. Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis. 2006;48:221–230.
Corrao AM, Lisi G, Di Pasqua G, Guizzardi M, Marino N, Ballone E, et al. Serum cystatin C as a reliable marker of changes in glomerular filtration rate in children with urinary tract malformations. J Urol. 2006;175:303–309.
Andersen TB, Jodal L, Boegsted M, Erlandsen EJ, Morsing A, Fronkiaer J, et al. GFR prediction from cystatin C and creatinine in children: Effect of including body cell mass. Am J Kidney Dis. 2012;59:50–57.
Flodin M, Hansson LO, Larsson A. Variations in assay protocol for the Dako cystatin C method may change patient results by 50% without changing the results for controls. Clin Chem Lab Med. 2006;44:1481–1485.
Grubb A, Nyman U, Björk J. Improved estimation of glomerular filtration rate (GFR) by comparison of eGFRcystatin C and eGFRcreatinine. Scand J Clin Lab Invest. 2012;72:73–77.
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Hari, P., Ramakrishnan, L., Gupta, R. et al. Cystatin C-based glomerular filtration rate estimating equations in early chronic kidney disease. Indian Pediatr 51, 273–277 (2014). https://doi.org/10.1007/s13312-014-0400-5