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Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function

  • Nephrology - Original Paper
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Abstract

Purpose

Serum creatinine is used ubiquitously to estimate glomerular filtration rate and to diagnose acute kidney injury after cardiac surgery. Serum cystatin C is a novel biomarker that has emerged as a possible diagnostic alternative to serum creatinine. It is unclear if the dynamic changes in serum cystatin C immediately following cardiopulmonary bypass (CPB) differ from those of serum creatinine in patients with normal preoperative kidney function.

Methods

We compared changes in serum levels of creatinine and cystatin C by measuring them serially in 19 patients undergoing CPB. Within-patient differences for serum creatinine and serum cystatin C were compared by repeated measures ANOVA.

Results

Serum creatinine and cystatin C levels showed significant correlation with each other. Both biomarkers showed a significant decrease after CPB, but their serum concentrations reverted to pre-CPB levels within 12 h. Serum levels of serum creatinine remained unchanged from baseline levels throughout 72-h post-CPB. In contrast, serum cystatin C levels rose further and became significantly higher compared to baseline within 48 h. Serum cystatin C remained significantly elevated at 48- and 72-h post-CPB.

Conclusions

Processes that determine the serum concentrations of serum creatinine and cystatin C in the post-CPB period affect the two biomarkers differently, suggesting that the two are not interchangeable as diagnostic markers of glomerular filtration rate. Future studies are needed to examine if these discrepancies are related to differences in their production rates, in their ability to detect small changes in glomerular filtration rate, or to a combination of these, and to determine the effect of such differences on the diagnostic and prognostic accuracy of the two biomarkers.

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Acknowledgments

The study was financed by Stiftelseförvaltningen–Hjärtfonden and US Stiftelse för medicinsk forskning: Hjärt-kärlforskning (92005). Part of this material was presented as oral presentation at 32nd Cardiothoracic Surgery Symposium and won the 13th Annual Utley Award in San Diego, February 29–March 3, 2012. Dr. Kovesdy is an employee of the US Department of Veterans Affairs. Opinions expressed in this paper are those of the authors and do not necessarily reflect the opinions of the US Department of Veterans Affairs.

Conflict of interest

None of the authors declared any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, 581 85, Linköping, Sweden

    Anders S. Svensson, John-Peder Escobar Kvitting, Magnus Rosén, Ingemar Cederholm & Zoltán Szabó

  2. Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden

    Anders S. Svensson, John-Peder Escobar Kvitting, Magnus Rosén, Ingemar Cederholm & Zoltán Szabó

  3. Division of Nephrology, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38103, USA

    Csaba P. Kovesdy

  4. Nephrology Section (111B), Memphis Veterans Affairs Medical Center, 1030 Jefferson Avenue, Room G409, Memphis, TN, 38104, USA

    Csaba P. Kovesdy

  5. Department of Physiology, Semmelweis University, Üllői Way 26, 1085, Budapest, Hungary

    Csaba P. Kovesdy

Authors
  1. Anders S. Svensson
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  2. Csaba P. Kovesdy
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  3. John-Peder Escobar Kvitting
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  4. Magnus Rosén
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Corresponding author

Correspondence to Csaba P. Kovesdy.

Electronic supplementary material

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11255_2013_403_MOESM1_ESM.tif

Online Figure 1 Mean (SD) serum creatinine values plotted over the first 72 h postoperatively. N = 19; *p < 0.05 compared to baseline. Supplementary material 1 (TIFF 313 kb)

11255_2013_403_MOESM2_ESM.tif

Online Figure 2 Mean (SD) serum cystatin C values plotted over the first 72 h postoperatively. N = 19; *p < 0.05 compared to baseline. Supplementary material 2 (TIFF 298 kb)

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Svensson, A.S., Kovesdy, C.P., Kvitting, JP.E. et al. Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function. Int Urol Nephrol 45, 1597–1603 (2013). https://doi.org/10.1007/s11255-013-0403-5

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  • DOI: https://doi.org/10.1007/s11255-013-0403-5

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