Cystatin C as a filtration marker – haemodialysis patients expose its strengths and limitations

Sjöström, Per; Jones, Ian; Tidman, M

doi:10.1080/00365510802326469

Cited by 18 publications

(21 citation statements)

References 40 publications

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“…Cystatin C predicts mortality in CKD independent of GFR (9). There has been interest in use of cystatin C as a marker of residual renal function (RRF) in both acute renal failure and ESRD (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…Previous data suggest that, at low GFR, the close relationship of cystatin C with GFR weakens (11). However, if cystatin C kinetics are predictable, then it may be possible to use parameters, such as predialysis cystatin C, to predict RRF.…”

Section: Introductionmentioning

confidence: 99%

“…Clearance of these molecules may be an important marker of adequate treatment in both peritoneal dialysis (10,16) and hemodialysis (HD) (11,17). Cystatin C has been proposed as a candidate for such a marker (18)(19)(20), but there are little data describing its removal and rebound kinetics in the maintenance HD population.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Vilar

Boltiador

Viljoen

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Cystatin C is a 13.3 kD middle molecule of similar size to b 2 -microglobulin and a marker of GFR in CKD. This study aimed to determine cystatin C kinetics in hemodialysis to understand whether blood concentrations may predict residual renal function and middle-molecule clearance.Design, setting, participants, & measurements Cystatin C removal and rebound kinetics were studied in 24 patients on high-flux hemodialysis or hemodiafiltration. To determine whether cystatin C concentrations are predictable, an iterative two-pool mathematical model was applied.Results Cystatin C was cleared effectively, although less than b 2 -microglobulin (reduction ratios6SD are 39%611 and 51%611). Cystatin C rebounded to 95%65% of predialysis concentration by 12 hours postdialysis. The two-pool kinetic model showed excellent goodness of fit. Modeled extracellular cystatin C pool volume is smaller than that predicted, comprising 25.5%69.2 of total body water. Iterated parameters, including nonrenal clearance, showed wide interindividual variation. Modeled nonrenal clearance was substantially higher than renal clearance in this population at 25.166.6 ml/min per 1.73 m 2 body surface area.Conclusions Plasma cystatin C levels may be used to measure middle-molecule clearance. Levels rebound substantially postdialysis and plateau in the interdialytic period. At low GFR, nonrenal clearance predominates over renal clearance, and its interindividual variation will limit use of cystatin C to predict residual renal function in advanced kidney disease.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Vilar

Boltiador

Viljoen

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Higher creatinine values have been associated with greater muscle mass and diets high in meat, and whilst cystatin C is less affected by these factors, other conditions associated with inflammation, including diabetes [25], smoking [26] and use of immunosuppressants [27], may affect cystatin C concentrations. C-reactive protein, a marker of inflammation, has been associated with higher values of cystatin C [25].…”

Section: Discussionmentioning

confidence: 99%

Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study

Barr

Maple-Brown

Barzi

et al. 2017

Clinical Biochemistry

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Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown.

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“…However, CV estimates in our study were corrected for creatinine CV , while CV Cr was not specifically associated with age. High intra-individual variability also occurs in another marker of glomerular filtration rate, cystatin C [39]. …”

Section: Discussionmentioning

confidence: 99%

Weight, Age and Coefficients of Variation in Renal Solute Excretion

2013

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Background: Homoscedasticity (constant variance over axes or among statistical factors) is an integral assumption of most statistical analyses. However, a number of empirical studies in model organisms and humans demonstrate significant differences in residual variance (that component of phenotype unexplained by known factors) or intra-individual variation among genotypes. Our work suggests that renal traits may be particularly susceptible to randomization by genetic and non-genetic factors, including endogenous variables like age and weight. Methods: We tested associ-ations between age, weight and intra-individual variation in urinary calcium, citrate, chloride, creatinine, potassium, magnesium, sodium, ammonium, oxalate, phosphorus, sulfate, uric acid and urea nitrogen in 9,024 male and 6,758 female kidney stone patients. Coefficients of variation (CVs) were calculated for each individual for each solute from paired 24-hour urines. Analysis of CVs was corrected for inter-measurement collection variance in creatinine and urine volume. CVs for sodium and urea nitrogen were included to correct for dietary salt and protein. Results: Age was positively associated with individual CVs for calcium and negatively associated with CVs for potassium, ammonium and phosphorus (p_FDR < 0.01). Weight was associated with CVs for creatinine, magnesium and uric acid, and negatively associated with CVs for calcium, potassium and oxalate (p_FDR < 0.05). Conclusion: Intra-individual variation changes over age and weight axes for numerous urinary solutes. Changing residual variance over age and weight could cause bias in the detection or estimation of genetic or environmental effects. New methodologies may need to account for such residual unpredictability, especially in diverse collections.

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Cystatin C as a filtration marker – haemodialysis patients expose its strengths and limitations

Cited by 18 publications

References 40 publications

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study

Weight, Age and Coefficients of Variation in Renal Solute Excretion

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