Cystatin C-based Equations in Renal Transplantation: Moving Toward a Better Glomerular Filtration Rate Prediction?

Maillard, Nicolas; Mariat, Christophe; Bonneau, Christine; Mehdi, M.; Thibaudin, Lise; Laporte, Silvy; Alamartine, Éric; Chamson, André; Berthoux, F

doi:10.1097/tp.0b013e3181744225

Cited by 44 publications

(30 citation statements)

References 17 publications

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“…Twenty percent of patients with stage 3 CKD using Mayo Clinic values had an eGFR greater than 60 ml/min per 1.73 m 2 using CHEO values. These results support the suggestion that interlaboratory differences contribute to some of the heterogeneity in equation performance observed in validation studies using Siemens' PENIA assay (13)(14)(15)(16).…”

Section: Discussionsupporting

confidence: 78%

“…Differences between PENIA, PETIA, and ELISA methodologies have been explored by a number of groups, with notable differences demonstrated (5,6). However, these studies do not address the variability in equation performance seen in studies that utilized the same methodology and manufacturer (13)(14)(15)(16). The purpose of this study was to examine the differences in CysC measured using Siemens' PENIA assay in two different laboratories experienced in measuring CysC and the effect any differences would have on GFR estimation.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Interlaboratory Differences in Cystatin C Assay Measurement on Glomerular Filtration Rate Estimation

White¹,

Rule²,

Collier³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Cystatin C (CysC) is a promising marker of GFR. Several equations have been derived to estimate GFR from its serum concentration. Heterogeneity in the performance of these equations exists in validation studies even when the same CysC assay from the same manufacturer is utilized. This study was designed to examine the differences in CysC and GFR estimation (eGFR) using Siemens' nephelometric immunoassay and the Mayo Clinic equation. The ability of the eGFRs to predict measured GFR was also examined.Design, setting, participants, & measurements Ninety-seven split samples were sent to laboratories at Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada, and at the Mayo Clinic in Rochester, Minnesota. ResultsThe mean CHEO CysC was 0.17 mg/L (10%) lower than the mean Mayo Clinic CysC. Using the Mayo Clinic equation, the mean eGFR difference was 7.2 ml/min per 1.73 m 2 (15%). Approximately 36% of the results agreed within 10%, while 13% were discordant by greater than 30%. Larger absolute differences in mean eGFR between the two laboratories were found in the subgroup with CysC less than 1.41 mg/L as compared with the subgroup greater than 1.41 mg/L (9.5 versus 5.0 ml/min per 1.73 m 2 ). Correction of CHEO values to the Mayo Clinic did not improve GFR estimation. Conclusions Significant differences in CysC measurement exist between laboratories using the same assay by the same manufacturer and these lead to clinically relevant differences in GFR estimation. This interlaboratory variability needs to be recognized when interpreting and comparing CysC and eGFR results.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

The Impact of Interlaboratory Differences in Cystatin C Assay Measurement on Glomerular Filtration Rate Estimation

White¹,

Rule²,

Collier³

et al. 2011

Clinical Journal of the American Society of Nephrology

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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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“…Although, some studies showed that CyC and or CyC-based equations predicted both patient mortality and graft outcome better than Crbased eGFR equations [34,84] , others founded that CyC and SCr were equally reliable predictors of graft outcome [85] . Interestingly, very recently, a study examined the extent to which the addition of serum CyC improves GFR estimation and mortality prediction, in comparison to various eGFR equations, in a population of 401 liver transplanted patients.…”

Section: Creatinine-based and Cyc-based Egfr Equations As Predictors mentioning

confidence: 99%

Estimating glomerular filtration rate in kidney transplantation: Still searching for the best marker

Santos

Martins

2015

WJN

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Kidney transplantation is the treatment of choice for endstage renal disease. The evaluation of graft function is mandatory in the management of renal transplant recipients. Glomerular filtration rate (GFR), is generally considered the best index of graft function and also a predictor of graft and patient survival. However GFR measurement using inulin clearance, the gold standard for its measurement and exogenous markers such as radiolabeled isotopes ( 51 Cr EDTA, 99m

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Cystatin C-based Equations in Renal Transplantation: Moving Toward a Better Glomerular Filtration Rate Prediction?

Cited by 44 publications

References 17 publications

The Impact of Interlaboratory Differences in Cystatin C Assay Measurement on Glomerular Filtration Rate Estimation

The Impact of Interlaboratory Differences in Cystatin C Assay Measurement on Glomerular Filtration Rate Estimation

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

Estimating glomerular filtration rate in kidney transplantation: Still searching for the best marker

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