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Cystatin C improves the diagnosis and stratification of chronic kidney disease, and the estimation of glomerular filtration rate in diabetes.
Diabetes Metab. 2008 Nov; 34(5):482-9.DM

Abstract

AIMS

Estimation of glomerular filtration rate (GFR) is recommended to diagnose and stratify chronic kidney disease (CKD). Can cystatin-C (cysC) assay improve the results in diabetic patients?

METHODS

In 124 diabetic patients with a wide range of GFR, as determined by 51Cr-EDTA clearance (i-GFR), we estimated 'e-GFR' by: the recommended Cockcroft-Gault (CG) formula and Modification of Diet in Renal Disease (MDRD) study equation; the new Mayo Clinic quadratic (MCQ) equation; the recently proposed composite estimation including both serum creatinine and cysC; and a simplified approach dividing the MDRD by cysC if less than 1.10mg/L.

RESULTS

The highest diagnostic accuracy (receiver operating characteristic [ROC] curves) and the highest proportions of well-stratified patients were obtained by cysC and the MDRD which, however, underestimated i-GFR for patients without CKD (-17%, P<0.001). The CG overestimated GFR in KDOQI stages 1 and 2, ignored stage 5 and was the least accurate. The MCQ equation overrepresented stage 2, overestimating GFR at this stage (+23%, P<0.005). The composite estimation (54.7+/-27.0mL per minute 1.73m(2)) correlated best with i-GFR (56.1+/-35.3; r=0.90, P<0.001), and did not significantly differ from it across the entire population and within each Kidney Disease Outcome Quality Initiative (KDOQI) stage but was also biased (Bland-Altman procedure). Simply dividing the MDRD by cysC ifless than1.10mg/L produced a comparable performance and eliminated the bias.

CONCLUSION

The recommended creatinine-based estimations of GFR need to be improved. CysC assay helps in the diagnosis and stratification of CKD and leads to better estimates of GFR in diabetic patients without any substantial increase in complexity.

Authors+Show Affiliations

Nutrition-diabétologie, hôpital Haut-Lévêque, avenue de Magellan, 33600 Pessac, France; Université de Bordeaux-II Victor-Segalen, 33000 Bordeaux, France. vincent.rigalleau@wanadoo.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

18703370

Citation

Rigalleau, V, et al. "Cystatin C Improves the Diagnosis and Stratification of Chronic Kidney Disease, and the Estimation of Glomerular Filtration Rate in Diabetes." Diabetes & Metabolism, vol. 34, no. 5, 2008, pp. 482-9.
Rigalleau V, Beauvieux MC, Le Moigne F, et al. Cystatin C improves the diagnosis and stratification of chronic kidney disease, and the estimation of glomerular filtration rate in diabetes. Diabetes Metab. 2008;34(5):482-9.
Rigalleau, V., Beauvieux, M. C., Le Moigne, F., Lasseur, C., Chauveau, P., Raffaitin, C., Perlemoine, C., Barthe, N., Combe, C., & Gin, H. (2008). Cystatin C improves the diagnosis and stratification of chronic kidney disease, and the estimation of glomerular filtration rate in diabetes. Diabetes & Metabolism, 34(5), 482-9. https://doi.org/10.1016/j.diabet.2008.03.004
Rigalleau V, et al. Cystatin C Improves the Diagnosis and Stratification of Chronic Kidney Disease, and the Estimation of Glomerular Filtration Rate in Diabetes. Diabetes Metab. 2008;34(5):482-9. PubMed PMID: 18703370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cystatin C improves the diagnosis and stratification of chronic kidney disease, and the estimation of glomerular filtration rate in diabetes. AU - Rigalleau,V, AU - Beauvieux,M-C, AU - Le Moigne,F, AU - Lasseur,C, AU - Chauveau,P, AU - Raffaitin,C, AU - Perlemoine,C, AU - Barthe,N, AU - Combe,C, AU - Gin,H, Y1 - 2008/08/13/ PY - 2007/12/10/received PY - 2008/03/16/revised PY - 2008/03/19/accepted PY - 2008/8/16/pubmed PY - 2009/2/26/medline PY - 2008/8/16/entrez SP - 482 EP - 9 JF - Diabetes & metabolism JO - Diabetes Metab VL - 34 IS - 5 N2 - AIMS: Estimation of glomerular filtration rate (GFR) is recommended to diagnose and stratify chronic kidney disease (CKD). Can cystatin-C (cysC) assay improve the results in diabetic patients? METHODS: In 124 diabetic patients with a wide range of GFR, as determined by 51Cr-EDTA clearance (i-GFR), we estimated 'e-GFR' by: the recommended Cockcroft-Gault (CG) formula and Modification of Diet in Renal Disease (MDRD) study equation; the new Mayo Clinic quadratic (MCQ) equation; the recently proposed composite estimation including both serum creatinine and cysC; and a simplified approach dividing the MDRD by cysC if less than 1.10mg/L. RESULTS: The highest diagnostic accuracy (receiver operating characteristic [ROC] curves) and the highest proportions of well-stratified patients were obtained by cysC and the MDRD which, however, underestimated i-GFR for patients without CKD (-17%, P<0.001). The CG overestimated GFR in KDOQI stages 1 and 2, ignored stage 5 and was the least accurate. The MCQ equation overrepresented stage 2, overestimating GFR at this stage (+23%, P<0.005). The composite estimation (54.7+/-27.0mL per minute 1.73m(2)) correlated best with i-GFR (56.1+/-35.3; r=0.90, P<0.001), and did not significantly differ from it across the entire population and within each Kidney Disease Outcome Quality Initiative (KDOQI) stage but was also biased (Bland-Altman procedure). Simply dividing the MDRD by cysC ifless than1.10mg/L produced a comparable performance and eliminated the bias. CONCLUSION: The recommended creatinine-based estimations of GFR need to be improved. CysC assay helps in the diagnosis and stratification of CKD and leads to better estimates of GFR in diabetic patients without any substantial increase in complexity. SN - 1262-3636 UR - https://www.unboundmedicine.com/medline/citation/18703370/Cystatin_C_improves_the_diagnosis_and_stratification_of_chronic_kidney_disease_and_the_estimation_of_glomerular_filtration_rate_in_diabetes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1262-3636(08)00146-8 DB - PRIME DP - Unbound Medicine ER -