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Chronic kidney disease stage in renal transplantation classification using cystatin C and creatinine-based equations.
Nephrol Dial Transplant. 2007 Oct; 22(10):3013-20.ND

Abstract

BACKGROUND

Current clinical guidelines recommend that renal transplant recipients (RTRs) be classified into chronic kidney disease (CKD) stage using a creatinine-based estimate of glomerular filtration rate (GFR). However, creatinine-based equations are inaccurate in RTRs leading to frequent CKD stage misclassification. It is not known whether the classification of CKD stage would be improved using a cystatin C-based estimate of GFR.

METHODS

We measured (99m)Tc-DTPA GFR, cystatin C and creatinine in 198 stable RTRs. GFR was estimated using cystatin C-based equations (Filler, Le Bricon and Rule) and four creatinine-based equations. We determined the proportion, overall and by CKD stage, that were classified correctly by each equation as compared to the (99m)Tc-DTPA GFR.

RESULTS

The Filler equation correctly classified 76% of patients compared to only 65% with the abbreviated modification of diet in renal disease (MDRD) equation and 69% with the Cockcroft-Gault equation. In CKD stages two and four, the Filler equation correctly classified 77% and 60% of patients whereas the abbreviated MDRD equation correctly classified 46% and 93% of patients. The area under the curve by receiver operating curve analysis for overall stage classification was uniformly poor for all equations (0.52-0.56).

CONCLUSIONS

The cystatin C-based Filler and Le Bricon GFR estimates classified slightly more patients into the correct CKD stage than the standard creatinine-based equations in stable RTRs although the overall diagnostic accuracies were similar. The differences are modest and prospective studies will be needed to determine if the adoption of these equations for classification would lead to improved recognition of CKD complications or patient care.

Authors+Show Affiliations

Division of Nephrology, Queen's University, Kingston, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17556417

Citation

White, Christine, et al. "Chronic Kidney Disease Stage in Renal Transplantation Classification Using Cystatin C and Creatinine-based Equations." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 22, no. 10, 2007, pp. 3013-20.
White C, Akbari A, Hussain N, et al. Chronic kidney disease stage in renal transplantation classification using cystatin C and creatinine-based equations. Nephrol Dial Transplant. 2007;22(10):3013-20.
White, C., Akbari, A., Hussain, N., Dinh, L., Filler, G., Lepage, N., & Knoll, G. A. (2007). Chronic kidney disease stage in renal transplantation classification using cystatin C and creatinine-based equations. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 22(10), 3013-20.
White C, et al. Chronic Kidney Disease Stage in Renal Transplantation Classification Using Cystatin C and Creatinine-based Equations. Nephrol Dial Transplant. 2007;22(10):3013-20. PubMed PMID: 17556417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic kidney disease stage in renal transplantation classification using cystatin C and creatinine-based equations. AU - White,Christine, AU - Akbari,Ayub, AU - Hussain,Naser, AU - Dinh,Laurent, AU - Filler,Guido, AU - Lepage,Nathalie, AU - Knoll,Greg A, Y1 - 2007/06/07/ PY - 2007/6/9/pubmed PY - 2008/1/15/medline PY - 2007/6/9/entrez SP - 3013 EP - 20 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 22 IS - 10 N2 - BACKGROUND: Current clinical guidelines recommend that renal transplant recipients (RTRs) be classified into chronic kidney disease (CKD) stage using a creatinine-based estimate of glomerular filtration rate (GFR). However, creatinine-based equations are inaccurate in RTRs leading to frequent CKD stage misclassification. It is not known whether the classification of CKD stage would be improved using a cystatin C-based estimate of GFR. METHODS: We measured (99m)Tc-DTPA GFR, cystatin C and creatinine in 198 stable RTRs. GFR was estimated using cystatin C-based equations (Filler, Le Bricon and Rule) and four creatinine-based equations. We determined the proportion, overall and by CKD stage, that were classified correctly by each equation as compared to the (99m)Tc-DTPA GFR. RESULTS: The Filler equation correctly classified 76% of patients compared to only 65% with the abbreviated modification of diet in renal disease (MDRD) equation and 69% with the Cockcroft-Gault equation. In CKD stages two and four, the Filler equation correctly classified 77% and 60% of patients whereas the abbreviated MDRD equation correctly classified 46% and 93% of patients. The area under the curve by receiver operating curve analysis for overall stage classification was uniformly poor for all equations (0.52-0.56). CONCLUSIONS: The cystatin C-based Filler and Le Bricon GFR estimates classified slightly more patients into the correct CKD stage than the standard creatinine-based equations in stable RTRs although the overall diagnostic accuracies were similar. The differences are modest and prospective studies will be needed to determine if the adoption of these equations for classification would lead to improved recognition of CKD complications or patient care. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/17556417/Chronic_kidney_disease_stage_in_renal_transplantation_classification_using_cystatin_C_and_creatinine_based_equations_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfm318 DB - PRIME DP - Unbound Medicine ER -