Assessment of Glomerular Filtration Rate in Renal Transplant Patients Using Serum Cystatin C

Xu, Hong‐Xi; Liu, Yanrong; Teng, D.; Wang, J.; Wang, L.; Li, Y.

doi:10.1016/j.transproceed.2006.07.014

Cited by 28 publications

(20 citation statements)

References 11 publications

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“…Plasma cystatin C (CystC), an endogenous lowmolecular-weight protein, overcomes PCr limitations (2,(5)(6)(7)(8). CystC meets only a few criteria of an ideal renal function marker because it is produced at a constant rate and is freely filtered in the glomerulus without tubular secretion; however, it is catabolized in the tubulus (9).…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Different Equations in Estimating GFR in Pediatric Kidney Transplant Recipients

Souza¹,

Cochat²,

Rabilloud³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objective The knowledge of renal function is crucial for the management of pediatric kidney transplant recipients. In this population, the most commonly used plasma creatinine (PCr)-based or cystatin C (CystC)-based GFR-predicting formulas may underperform (e.g., corticosteroids and trimethoprim may affect PCr concentration, whereas prednisone and calcineurin inhibitors may affect CystC concentration). This study evaluated the performance of six formulas in pediatric kidney transplant recipients.Design, setting, participants, & measurements The study used PCr-based formulas (bedside Schwartz, SchwartzLyon), CystC-based formulas (Hoek, Filler), and combined PCr-CystC-based formulas (CKD in Children [CKiD] 2012 and Zappitelli). The performance of these formulas was compared using inulin clearance as reference and assessed according to CKD stages in a historical cohort that included 73 pediatric kidney transplant recipients (199 measurements). The ability of the formulas to identify GFRs,60, ,75, and ,90 ml/min per 1.73 m 2 was assessed.Results At measured GFR (mGFR) $90 ml/min per 1.73 m 2 (nine patients; 23 measurements), the Zappitelli formula had the highest 30% accuracy (P30) (95% [95% confidence interval (95% CI), 87% to 100%]) and the bedside Schwartz had the highest 10% accuracy (P10) (56% [95% CI, 32% to 72%]). At mGFR$60 and ,90 ml/min per 1.73 m 2 (22 patients; 91 measurements), all formulas had P30 values .80%. However, only the CKiD 2012 formula had a P10 value .50%. At mGFR,60 ml/min per 1.73 m 2 (42 patients; 85 measurements), the CKiD 2012 and Schwartz-Lyon formulas had the highest P10 (45% [95% CI, 34% to 55%] and 43% [95% CI, 33% to 54%]) and P30 (90% [95% CI, 84% to 97%] and 91% [95% CI, 86% to 98%]). All studied equations except Hoek and Filler had areas under the receiver-operating characteristic curves significantly .90% in discriminating patients with renal dysfunction at various CKD stages (GFR,60, ,75, and ,90 ml/min per 1.73 m 2 ).Conclusions In pediatric kidney transplant recipients, the CKiD 2012 formula had the best performance at mGFRs,90 ml/min per 1.73 m 2 . CystC-based formulas were not superior to PCr-based formulas.

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Section: Introductionmentioning

confidence: 99%

Accuracy of Different Equations in Estimating GFR in Pediatric Kidney Transplant Recipients

Souza¹,

Cochat²,

Rabilloud³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…These properties have made it an attractive marker of the GFR in chronic kidney disease (4,5). However, receipt of glucocorticoids, age, gender, and C-reactive protein are nonrenal factors that may affect the measurement of plasma CysC (6,7). There is a relative paucity of information on the plasma levels of CysC after acute kidney insults such as those associated with CPB.…”

mentioning

confidence: 99%

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Wald

Liangos

Perianayagam

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:Little is known about the performance of plasma cystatin C (CysC) in patients undergoing cardiopulmonary bypass (CPB) and its utility in the early diagnosis of acute kidney injury (AKI). In this post hoc analysis, the goal was to determine whether plasma cystatin C, measured 2 hours after the conclusion of CPB, is a reliable marker of AKI.Design, setting, participants, & measurements: Plasma CysC was measured in 150 patients undergoing CPB at the following times: preoperatively, 2 hours after the conclusion of CPB, postoperative day 1, and postoperative day 2. Plasma CysC levels were related to the development of AKI as defined by an increase in serum creatinine of >50% or >0.3 mg/dl from baseline up to 3 days postoperative. Mixed linear models were used to evaluate the relationship of serial plasma CysC values with AKI. The discriminatory capacity of plasma CysC was estimated using receiver operating characteristic curves. Logistic regression was utilized to assess the adjusted relationship between plasma CysC and subsequent AKI.Results: AKI developed in 47 (31.3%) patients. Plasma CysC was higher at all times among patients who developed AKI compared with those who did not (P < 0.0001). The discriminatory capacity of plasma CysC measured preoperatively and 2 hours after the conclusion of CPB was modest.Conclusions: Serial measures of plasma CysC are highly correlated with the development of AKI. However, the discriminatory capacity of plasma CysC as an early marker of AKI remains limited.

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“…Higher serum CysC levels and underestimation of GFR have been found in children on glucocorticoid therapy in the immediate post-transplant period and in situations of acute rejection. On the other hand, the effect of other immunosuppressive medications such as tacrolimus, mycophenolate mofetil or azathioprine on CysC concentration has not been reported, except for cyclosporine A, which appeared to promote a decrease in CysC levels (24). In our study, patients were evaluated more than one year after the transplant when the steroid dose used was much lower (0.1 mg·kg -1 ·day -1 ), and was unlikely to have influenced CysC measurements.…”

Section: Discussionmentioning

confidence: 71%

“…CysC may have limitations as a marker of renal function, since there are potential factors other than GFR that have been reported to affect serum levels of CysC including older age, male gender, smoking, higher weight, higher levels of C-reactive protein, and thyroid dysfunction (8,20). Moreover, recent studies have reported that CysC levels are affected by treatment with high steroid doses (21)(22)(23)(24). Higher serum CysC levels and underestimation of GFR have been found in children on glucocorticoid therapy in the immediate post-transplant period and in situations of acute rejection.…”

Section: Discussionmentioning

confidence: 99%