Cystatin C is not a reliable marker of residual glomerular filtration rate during continuous renal replacement therapy

Kiers, Dorien; Sévaux, R Gl de; Pickkers, Peter

doi:10.1007/s00134-011-2346-6

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Kiers et al . [ 36 ] observed that Cys-C (13 kDa) concentrations in six septic shock patients undergoing continuous RRT decreased significantly following initiation of continuous veno-venous hemofiltration within the first 24 hours ( P = 0.04). In the study by Mayeur et al .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of neutrophil gelatinase-associated lipocalin, cystatin C, and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury

Dai

Zeng

et al. 2015

Crit Care

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IntroductionNeutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys-C), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) are novel diagnostic biomarkers of acute kidney injury (AKI). We aimed to determine the diagnostic properties of these biomarkers for detecting AKI in critically ill patients with sepsis.MethodsWe divided 112 patients with sepsis into non-AKI sepsis (n = 57) and AKI sepsis (n = 55) groups. Plasma and urine specimens were collected on admission and every 24 hours until 72 hours and tested for NGAL, Cys-C, and TREM-1 concentrations. Their levels were compared on admission, at diagnosis, and 24 hours before diagnosis.ResultsBoth plasma and urine NGAL, Cys-C, and sTREM-1 were significantly associated with AKI development in patients with sepsis, even after adjustment for confounders by using generalized estimating equations. Compared with the non-AKI sepsis group, the sepsis AKI group exhibited markedly higher levels of these biomarkers at diagnosis and 24 hours before AKI diagnosis (P <0.01). The diagnostic and predictive values of plasma and urine NGAL were good, and those of plasma and urine Cys-C and sTREM-1 were fair.ConclusionPlasma and urine NGAL, Cys-C, and sTREM-1 can be used as diagnostic and predictive biomarkers for AKI in critically ill patients with sepsis.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of neutrophil gelatinase-associated lipocalin, cystatin C, and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury

Dai

Zeng

et al. 2015

Crit Care

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“…Serum cystatin C has been proposed as a marker of residual renal function during CVVH by some authors [43,44]. However, this finding has been questioned by the observation that based on the modality cystatin can drop significantly after initiation of RRT indicating significant extracorporeal clearance [44].…”

Section: Novel Biomarkersmentioning

confidence: 99%

“…Again, there is significant heterogeneity in both the timings and the threshold values used in reported studies, ranging from 1.85 mg/l at discontinuation [41] to 2.98 mg/l on ICU admission [42]. Serum cystatin C has been proposed as a marker of residual renal function during CVVH by some authors [43,44]. However, this finding has been questioned by the observation that based on the modality cystatin can drop significantly after initiation of RRT indicating significant extracorporeal clearance [44].…”

Section: Predictors Of Successful Discontinuation Of Renal Replacemen...mentioning

confidence: 99%

When to discontinue renal replacement therapy. what do we know?

Boyer,

Perschinka,

Joannidis

et al. 2023

Current Opinion in Critical Care

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Purpose of review Acute kidney injury is common in intensive care patients. Supportive care involves the use of renal replacement therapies as organ support. Initiation of renal replacement therapy has been the subject of much interest over the last few years with several randomised controlled studies examining the optimal time to commence treatment. In contrast to this, little evidence has been generated regarding cessation of therapy. Given that this treatment is complex, not without risk and expensive it seems timely that efforts should be expended at examining this vexing issue. Recent findings Although several studies have been reported examining the successful discontinuation of renal replacement therapies all studies reported to-date are observational in nature. Conventional biochemical criteria have been used as well as physiological parameters including urine output. More recently, more novel biomarkers of renal function have been studied. Although to-date no optimal variable nor threshold for discontinuation can be established. Summary Several variables have been described which may have a role in determining which patients may be successfully weaned from renal replacement therapy. However, few have been exposed to vigorous examination and evidence is sparse in support of any potential approach although urine output currently is the most often described. More recently novel biomarkers have also been examined but again are limited by study design and heterogeneity. Further research is clearly needed focussing on proposed variables preferably in multivariate models to improve predictive ability and successful cessation of therapy.

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“…Hypothyroidism decreases and hyperthyroidism increases the production of cystatin C . Dialysis and haemofiltration remove cystatin C .…”

Section: Introductionmentioning

confidence: 99%

Role of biomarkers of nephrotoxic acute kidney injury in deliberate poisoning and envenomation in less developed countries

Mohamed

Endre

Buckley

2015

Brit J Clinical Pharma

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Acute kidney injury (AKI) has diverse causes and is associated with increased mortality and morbidity. In less developed countries (LDC), nephrotoxic AKI (ToxAKI) is common and mainly due to deliberate ingestion of nephrotoxic pesticides, toxic plants or to snake envenomation. ToxAKI shares some pathophysiological pathways with the much more intensively studied ischaemic AKI, but in contrast to ischaemic AKI, most victims are young, previously healthy adults. Diagnosis of AKI is currently based on a rise in serum creatinine. However this may delay diagnosis because of the kinetics of creatinine. Baseline creatinine values are also rarely available in LDC. Novel renal injury biomarkers offer a way forward because they usually increase more rapidly in AKI and are normally regarded as absent or very low in concentration, thereby reducing the need for a baseline estimate. This should increase sensitivity and speed of diagnosis. Specificity should also be increased for urine biomarkers since many originate from the renal tubular epithelium. Earlier diagnosis of ToxAKI should allow earlier initiation of appropriate therapy. However, translation of novel biomarkers of ToxAKI into clinical practice requires better understanding of non-renal factors in poisoning that alter biomarkers and the influence of dose of nephrotoxin on biomarker performance. Further issues are establishing LDC population-based normal ranges and assessing sampling and analytical parameters for low resource settings. The potential role of renal biomarkers in exploring ToxAKI aetiologies for chronic kidney disease of unknown origin (CKDu) is a high research priority in LDC. Therefore, developing more sensitive biomarkers for early diagnosis of nephrotoxicity is a critical step to making progress against AKI and CKDu in the developing world.

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Cystatin C is not a reliable marker of residual glomerular filtration rate during continuous renal replacement therapy

Cited by 6 publications

References 5 publications

Diagnostic value of neutrophil gelatinase-associated lipocalin, cystatin C, and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury

Diagnostic value of neutrophil gelatinase-associated lipocalin, cystatin C, and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury

When to discontinue renal replacement therapy. what do we know?

Role of biomarkers of nephrotoxic acute kidney injury in deliberate poisoning and envenomation in less developed countries

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