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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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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

This study was supported in part by a grant from the Japanese Society of Nephrology and Health and Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare, Japan.

Author information

Authors and Affiliations

  1. Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan

    Masaru Horio

  2. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Enyu Imai, Yoshinari Yasuda & Seiichi Matsuo

  3. Third Department of Medicine, Fukushima Medical University, Fukushima, Japan

    Tsuyoshi Watanabe

Authors
  1. Masaru Horio
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  2. Enyu Imai
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  3. Yoshinari Yasuda
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  4. Tsuyoshi Watanabe
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  5. Seiichi Matsuo
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Corresponding author

Correspondence to Masaru Horio.

Additional information

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

Appendix

Appendix

The following investigators participated in the project for developing the Japanese equation for estimating GFR: Asahikawa Medical University; Kenjiro Kikuchi, Masakazu Haneda: Hokkaido University Hospital; Seiji Hashimoto: Sapporo Medical University; Nobuyuki Ura: Tohoku University Hospital; Sadayoshi Ito, Hiroshi Sato: Fukushima Medical University; Tsuyoshi Watanabe: Jichi Medical University; Yasuhiro Ando, Eiji Kusano: Gunma University; Yoshihisa Nojima: University of Tsukuba; Kunihiro Yamagata, Chie Saitoh: Toride Kyodo General Hospital; Tatsuo Shiigai, Yoshitaka Maeda: Saitama Medical University; Hiromichi Suzuki, Yusuke Watanabe: Saitama Medical University; Tetsuya Mitarai, Hajime Hasegawa: The University of Tokyo; Toshiro Fujita: Jikei University; Tatsuo Hosoya: Nihon University; Koichi Matsumoto, Takayuki Fujita: Tokyo Women’s Medical University; Kousaku Nitta: Tokyo Women’s Medical University Medical Center East; Tsutomu Sanaka: Tokyo Medical and Dental University; Eiichiro Kanda, Sei Sasaki: Juntendo University; Yasuhiko Tomino: Tokyo Medical University Hospital; Toshiyuki Nakano: Showa University; Tadao Akizawa, Hirokazu Honda: Showa University Fujigaoka Hospital; Yoshihiko Inoue, Ashio Yoshimura: Toranomon Hospital; Hiroshi Tsuji: Toho University; Yasushi Ohashi: Teikyo University; Hideaki Nakajima Shunya Uchida: Kyorin University; Akira Yamada: Yokohama City University; Satoshi Umemura, Mai Yanagi: St. Marianna University; Hiro Yamakawa, Kenjiro Kimura: Niigata University; Shinichi Nishi, Fumitake Gejyo: Hamamatsu University; Akira Hishida, Hideo Yasuda, Tomoyuki Fujikura: Nagoya University; Seiichi Matsuo: Aichi Medical University; Hirokazu Imai, Wataru Kitagawa: Fujita Health University Hospital; Satoshi Sugiyama: Mie University; Shinsuke Nomura, Eiji Ishikawa: Toyama Prefectural Central Hospital; Masahiko Kawabata: Hiroyuki Iida: Kanazawa University Hospital; Takashi Wada: Kanazawa Medical University; Hitoshi Yokoyama: University of Fukui Hospital; Haruyoshi Yoshida: Shiga University of Medical Science; Takashi Uzu, Masayoshi Sakaguchi: Kyoto University Hospital, Atsushi Fukatsu: Osaka University; Yasuyuki Nagasawa, Shiro Takahara: Osaka City University; Eiji Ishimura, Yoshiki Nishizawa: Kobe University; Masafumi Fukagawa, Michio Umezu: Hyogo College of Medicine; Nakanishi Takeshi, Izumi Masaaki: Okayama University, Hitoshi Sugiyama, Hirofumi Makino: Kawasaki Medical School; Naoki Kashihara, Tamaki Sasaki: Hiroshima University; Noriaki Yorioka: University of Tokushima; Toshio Doi: Kagawa University; Masakazu Kono: Ehime University; Takafumi Okura: Kyushu University Hospital; Kazuhiko Tsuruya, Akiko Ono: Fukuoka University; Takao Saito, Yasuhiro Abe: Nagasaki University; Akira Furusu: Kurume University; Seiya Okuda: Kumamoto University; Kimio Tomita: University of Miyazaki; Shouichi Fujimoto: University Hospital of The Ryukyus; Iseki Kunitoshi, Schuichi Takishita: Koto Hospital; Isao Ebihara, Yuko Shima: Nara Medical University; Koji Harada, Yoshihiko Saito: Dokkyo Medical University; Atsushi Numabe, Toshihiko Ishimitsu: Kitano Hospital; Eri Muso, Toshiyuki Komiya: Musashino Red Cross Hospital; Ryoichi Ando: Toyonaka Municipal Hospital; Megumu Fukunaga: Ohmihachiman Community Medical Center; Tsuguru Hatta: Sendai Shakaihoken Hospital; Osamu Hota: Tosei General Hospital; Inaguma Daijo: Matsuyama Clinic; Kazuhiro Matsuyama: Rokko Island Hospital; Naoyuki Nakano: Shuwa General Hospital; Masashi Inoshita: Kanagawa Rehabilitation Hospital; Masahisa Kusaka, Masato Mizuguchi.

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Horio, M., Imai, E., Yasuda, Y. et al. Performance of serum cystatin C versus serum creatinine as a marker of glomerular filtration rate as measured by inulin renal clearance. Clin Exp Nephrol 15, 868–876 (2011). https://doi.org/10.1007/s10157-011-0525-y

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