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Comparison of cystatin C and creatinine-based equations for GFR estimation after living kidney donation.
Transplantation. 2014 Oct 27; 98(8):871-7.T

Abstract

BACKGROUND

The performance of glomerular filtration rate (GFR) equations incorporating both cystatin C (CysC) and serum creatinine (Creat) in living kidney donors has not been studied before.

METHODS

From a population of 3,698 living kidney donors, 257 donors were randomly selected to undergo GFR measurement (mGFR) by the plasma disappearance of iohexol. GFR was estimated with the Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease Epidemiology Collaboration study eGFR(CKD-EPI-Creat) in 257 donors and the two newly developed equations using CysC with and without Creat, eGFR(CKD-EPI-CysC) and eGFR(CKD-EPI-Creat+CysC), in 215 donors.

RESULTS

Mean mGFR was 71.8±11.8 mL/min/1.73 m. The eGFR(MDRD) exhibited least and only negative bias and the three other models were comparable in terms of bias. The eGFR(CKD-EPI-Creat+CysC) equation was most precise; r=0.64. Both eGFR(MDRD) and eGFR(CKD-EPI-Creat+CysC) had high percentage (94.4% and 92.6%, respectively) of estimates falling within 30% of mGFR versus estimates by eGFR(CKD-EPI-Creat) and eGFR(CKD-EPI-CysC) equations (87.2% and 85.1%, respectively). The eGFR(MDRD) was by far most accurate in identifying those with mGFR less than 60 mL/min/1.73 m whereas the CKD-EPI models were extremely accurate in classifying those with mGFR greater than or equal to 60 mL/min/1.73 m.

CONCLUSIONS

eGFR(CKD-EPI-Creat+CysC) equation provides comparable accuracy to the eGFR(MDRD) in overall estimation of mGFR, but with higher precision. However, eGFR(CKD-EPI-Creat+CysC) clearly misses many of those with a post-donation GFR less than 60 mL/min/1.73 m and therefore eGFR(MDRD) is preferable in detecting donors with GFR less than 60 mL/min/1.73 m.

Authors+Show Affiliations

1 Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN. 2 Division of Nephrology, University of Alabama, Birmingham, AL. 3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 4 Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN. 5 Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 6 Address correspondence to: Hassan N. Ibrahim, M.D., M.S., Division of Renal Diseases and Hypertension, University of Minnesota, 717 Delaware Street SE, Suite 353, Mail Code 1932, Minneapolis, MN 55414.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24825515

Citation

Issa, Naim, et al. "Comparison of Cystatin C and Creatinine-based Equations for GFR Estimation After Living Kidney Donation." Transplantation, vol. 98, no. 8, 2014, pp. 871-7.
Issa N, Kukla A, Jackson S, et al. Comparison of cystatin C and creatinine-based equations for GFR estimation after living kidney donation. Transplantation. 2014;98(8):871-7.
Issa, N., Kukla, A., Jackson, S., Riad, S. M., Foster, M. C., Matas, A. J., Eckfeldt, J. H., & Ibrahim, H. N. (2014). Comparison of cystatin C and creatinine-based equations for GFR estimation after living kidney donation. Transplantation, 98(8), 871-7. https://doi.org/10.1097/TP.0000000000000129
Issa N, et al. Comparison of Cystatin C and Creatinine-based Equations for GFR Estimation After Living Kidney Donation. Transplantation. 2014 Oct 27;98(8):871-7. PubMed PMID: 24825515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of cystatin C and creatinine-based equations for GFR estimation after living kidney donation. AU - Issa,Naim, AU - Kukla,Aleksandra, AU - Jackson,Scott, AU - Riad,Samy M, AU - Foster,Meredith C, AU - Matas,Arthur J, AU - Eckfeldt,John H, AU - Ibrahim,Hassan N, PY - 2014/5/15/entrez PY - 2014/5/16/pubmed PY - 2014/12/17/medline SP - 871 EP - 7 JF - Transplantation JO - Transplantation VL - 98 IS - 8 N2 - BACKGROUND: The performance of glomerular filtration rate (GFR) equations incorporating both cystatin C (CysC) and serum creatinine (Creat) in living kidney donors has not been studied before. METHODS: From a population of 3,698 living kidney donors, 257 donors were randomly selected to undergo GFR measurement (mGFR) by the plasma disappearance of iohexol. GFR was estimated with the Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease Epidemiology Collaboration study eGFR(CKD-EPI-Creat) in 257 donors and the two newly developed equations using CysC with and without Creat, eGFR(CKD-EPI-CysC) and eGFR(CKD-EPI-Creat+CysC), in 215 donors. RESULTS: Mean mGFR was 71.8±11.8 mL/min/1.73 m. The eGFR(MDRD) exhibited least and only negative bias and the three other models were comparable in terms of bias. The eGFR(CKD-EPI-Creat+CysC) equation was most precise; r=0.64. Both eGFR(MDRD) and eGFR(CKD-EPI-Creat+CysC) had high percentage (94.4% and 92.6%, respectively) of estimates falling within 30% of mGFR versus estimates by eGFR(CKD-EPI-Creat) and eGFR(CKD-EPI-CysC) equations (87.2% and 85.1%, respectively). The eGFR(MDRD) was by far most accurate in identifying those with mGFR less than 60 mL/min/1.73 m whereas the CKD-EPI models were extremely accurate in classifying those with mGFR greater than or equal to 60 mL/min/1.73 m. CONCLUSIONS: eGFR(CKD-EPI-Creat+CysC) equation provides comparable accuracy to the eGFR(MDRD) in overall estimation of mGFR, but with higher precision. However, eGFR(CKD-EPI-Creat+CysC) clearly misses many of those with a post-donation GFR less than 60 mL/min/1.73 m and therefore eGFR(MDRD) is preferable in detecting donors with GFR less than 60 mL/min/1.73 m. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/24825515/Comparison_of_cystatin_C_and_creatinine_based_equations_for_GFR_estimation_after_living_kidney_donation_ L2 - https://doi.org/10.1097/TP.0000000000000129 DB - PRIME DP - Unbound Medicine ER -