Comparing Newer GFR Estimating Equations Using Creatinine and Cystatin C to the CKD-EPI Equations in Adults

Levey, Andrew S.; Tighiouart, Hocine; Simon, Andrew; Inker, Lesley A.

doi:10.1053/j.ajkd.2017.04.012

Cited by 33 publications

(21 citation statements)

References 12 publications

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“…Similar equations have been developed to estimate GFR from cystatin C. Several studies, summarized in Table 1, have compared cystatin Cbased equations with the Schwartz, Cockcroft-Gault, and MDRD equations and found cystatin C-based equations to be superior estimates of GFR. 7,8,21,43 These studies suggest that creatinine-based equations overestimated GFR, leading to false negatives, while cystatin C equations showed no bias. This was recently highlighted in a Japanese clinical trial involving patients treated with dolutegravir for antiretroviral HIV therapy.…”

Section: Equations For Estimating Gfr Using Cystatin Cmentioning

confidence: 79%

“…Due to the limitations of creatinine, eGFR equations incorporating anthropometric data are commonly used in clinical practice. Similar equations have been developed to estimate GFR from cystatin C. Several studies, summarized in Table , have compared cystatin C–based equations with the Schwartz, Cockcroft‐Gault, and MDRD equations and found cystatin C–based equations to be superior estimates of GFR . These studies suggest that creatinine‐based equations overestimated GFR, leading to false negatives, while cystatin C equations showed no bias.…”

Section: Equations For Estimating Gfr Using Cystatin Cmentioning

confidence: 99%

“…In contrast, the MDRD equation with creatinine is derived from 1628 patients across multiple centers . Perhaps due to this limitation and variance among populations, some studies comparing eGFR equations find no improvement in accuracy when using cystatin C–based equations . This has led to differing views as to which eGFR equations to employ.…”

Section: Limitations Of Cystatin C As a Gfr Biomarkermentioning

confidence: 99%

“…8 Perhaps due to this limitation and variance among populations, some studies comparing eGFR equations find no improvement in accuracy when using cystatin C-based equations. 43 This has led to differing views as to which eGFR equations to employ. Some studies recommend that if cystatin C is measured as a secondary test based on the results of creatinine, then cystatin Cbased eGFR equations should be calculated instead of combined equations so that creatinine level does not influence verification of a GFR.…”

Section: Limitations Of Cystatin C As a Gfr Biomarkermentioning

confidence: 99%

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Cystatin C Is a More Reliable Biomarker for Determining eGFR to Support Drug Development Studies

Kar

Paglialunga

Islam

2018

The Journal of Clinical Pharma

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Glomerular filtration rate (GFR) is routinely used as a surrogate endpoint for the development of investigational drugs in clinical trials. GFR and staging of chronic kidney disease are typically assessed by measuring the concentration of endogenous serum biomarkers such as albumin and creatinine. However, creatinine is subject to high biological variability, and levels of creatinine do not rise until nearly 50% of kidney function is damaged, leading to inaccurate chronic kidney disease staging and false negatives. A newer biomarker for GFR, cystatin C, has been shown to be subject to less biological interference and more sensitive to early declines in kidney function. Cystatin C has also been shown to outperform creatinine as an indicator of true GFR and to add information about the occurrence of acute kidney injury. Comparison studies of cystatin C and creatinine continue to demonstrate its increased accuracy and sensitivity for changes in true GFR. While challenges remain for use of cystatin C, international agencies and working groups continue to validate cystatin C as a biomarker and accompanying GFR estimating equations for diagnostic and drug development use. In this review, we summarize these comparison studies, regulatory and industry guidelines, and clinical trial case studies for use of cystatin C in drug development.

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Section: Equations For Estimating Gfr Using Cystatin Cmentioning

confidence: 79%

Section: Equations For Estimating Gfr Using Cystatin Cmentioning

confidence: 99%

Section: Limitations Of Cystatin C As a Gfr Biomarkermentioning

confidence: 99%

Section: Limitations Of Cystatin C As a Gfr Biomarkermentioning

confidence: 99%

See 2 more Smart Citations

Cystatin C Is a More Reliable Biomarker for Determining eGFR to Support Drug Development Studies

Kar

Paglialunga

Islam

2018

The Journal of Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…11,18 Since the KDIGO guidelines were published, other cystatin and creatinie-cystatin C equations using standardized assays have been developed including Caucasian and Asian pediatric and adult subjects, Full Age Spectrum, Berlin Initiative Study, but none have been shown to be more accurate than CKD-EPI equation. 16,17 However, as Inker, Coresh, and Levey describe in their article on the multiple marker approach to GFR estimation, cystatin C also has non-GFR determinants of its serum creatinine. As such, GFR estimates based on cystatin C alone or even in combination with creatinine are not sufficient for many key clinical decisions and other markers are likely required for highly accurate GFR estimation.…”

mentioning

confidence: 99%