Assessment of glomerular filtration rate by serum cystatin C in patients undergoing coronary artery bypass grafting

Wang, Qingping; J, Gu; Zhan, Xianghong; Li, Hui; Luo, Xi

doi:10.1258/acb.2009.009065

Cited by 22 publications

(12 citation statements)

References 36 publications

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“…However since most of those studies did not provide a reference GFR measurement against which SCr and SCysC could be thoroughly compared, the real added value of SCysC as a marker of GFR has remained partly speculative [6]. Among all these studies, only two of them realized after cardiac surgery have measured GFR by a reference method (iohexol or 51 Cr-EDTA) and showed superior performance of cystatin C [18,19]. Focusing specifically on critically ill patients, Le Bricon et al measured GFR by a reference method ( 51 Cr-EDTA) and showed a better correlation between 1/cystatin C and GFR than between 1/creatinine and GFR (r = 0.755 versus r = 0.686).…”

Section: Discussionmentioning

confidence: 99%

Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versusserum creatinine

et al. 2014

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BackgroundDetecting impaired glomerular filtration rate (GFR) is important in intensive care units (ICU) in order to diagnose acute kidney injuries and adjust the dose of renally excreted drugs. Whether serum Cystatin C (SCysC) may better reflect glomerular filtration rate than serum creatinine (SCr) in the context of intensive care medicine is uncertain.MethodsWe compared the performance of SCysC and SCr as biomarkers of GFR in 47 critically ill patients (median SOFA (Sepsis-related Organ Failure Assessment) score of 5) for whom GFR was measured by a reference method (urinary clearance of iohexol).ResultsMean Iohexol clearance averaged 96 ± 54 mL/min and was under 60 mL/min in 28% of patients. Mean SCr and SCysC concentrations were 0.70 ± 0.33 mg/dL and 1.26 ± 0.61 mg/L, respectively. Area under the ROC curve for a GFR threshold of 60 mL/min was 0.799 and 0.942 for SCr and SCysC, respectively (p = 0.014).ConclusionsWe conclude that ScysC significantly outperfoms SCr for the detection of an impaired GFR in critically ill patients.Trial registrationClinicalTrials.gov: B7072006347

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Section: Discussionmentioning

confidence: 99%

Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versusserum creatinine

et al. 2014

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“…In the studies of adult patients undergoing CS, urinary Cys C was able to detect AKI within 6 h after surgery [23] and serum Cys C had showed to be a better marker for detecting small temporary changes of GFR than sCr or creatinine clearance allowing better identification of patients who developed renal impairment [24]. In a study of 60 patients who underwent heart valve replacement surgery, serum Cys C was superior to creatinine in diagnosing renal dysfunction (AUC 0.876 for Cys C vs. 0.801 for sCr) [22].…”

Section: Novel Renal Biomarkers For Cardio-renal Syndromementioning

confidence: 99%

Laboratory parameters of cardiac and kidney dysfunction in cardio-renal syndromes

et al. 2011

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"Cardio-Renal Syndromes" (CRS) are disorders of the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pathophysiology of CRS is complex, and there is accumulating evidence that various novel biomarkers are useful for diagnosis, prognostication, and risk stratification in patients with heart failure and chronic kidney disease (CRS). When both the heart failure (HF) and CKD occur together, it is important to have biomarkers that are able to risk stratify patients by looking at both their heart and kidney aspects. There are some promising newer renal biomarkers that may contribute to a better evaluation and prediction of prognosis in CRS patients. Most of the renal biomarkers studies in CRS have been performed in the setting of cardiac surgery, acute coronary syndrome (ACS), HF or after exposure to radiocontrast media in diagnostic and/or therapeutic percutaneous coronary procedures. Natriuretic peptides (NPs) have been validated as an important cardiac biomarker for risk stratification and prognostication in HF patients with or without CKD. However, the best cutoff values for each stage of CKD, including those on renal replacement therapy, are yet to be ascertained. In this context, it is likely that panels of multiple biomarkers will be needed for optimal evaluation, risk stratification, timely treatment initiation, and follow-up of patients with CRS.

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“…[18-20;28;29] It holds advantages over serum creatinine in that it is unaffected by the demographic characteristics that determine muscle mass and hence serum creatinine level, and its serum levels are also unaffected by tubular secretion. [21;22] Cystatin C has been shown to be a reliable marker of GFR in patients undergoing cardiac surgery, [18][19][20] but its ability to supersede serum creatinine for monitoring changes in GFR in the immediate post-operative period (which is the most important time period for the development of AKI) remains controversial. Some studies have suggested that serum cystatin C may be able to diagnose postoperative AKI more rapidly than serum creatinine, [23] but others have been unable to confirm this.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20] Cystatin C is a 13,25 kDa protein produced by all nucleated cells in the human body. [21] It is freely filtered in the glomerulus, then reabsorbed by epithelial cells in the proximal tubule where it is metabolized and not returned to the systemic circulation.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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 hours. Serum levels of serum creatinine remained unchanged from baseline levels throughout 72 hours post-CPB. In contrast, serum cystatin C levels rose further, and became significantly higher compared to baseline within 48 hours. Serum cystatin C remained significantly elevated at 48 and 72 hours 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 GFR, 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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Assessment of glomerular filtration rate by serum cystatin C in patients undergoing coronary artery bypass grafting

Abstract: Cystatin C is a better marker for detecting small temporary changes of GFR in CABG patients. This may allow better identification of patients with renal impairment.

Cited by 22 publications

References 36 publications

Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versusserum creatinine

Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versusserum creatinine

Laboratory parameters of cardiac and kidney dysfunction in cardio-renal syndromes

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

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