Glomerular filtration rate estimation in patients with type 2 diabetes: creatinine- or cystatin C-based equations?

Abstract

Aims/hypothesis It is argued that GFR estimation (eGFR) using cystatin C-based equations (eGFRcys) is superior to that using creatinine-based equations (eGFRcre). We investigated whether eGFRcys are superior to eGFRcre in patients with type 2 diabetes. Methods GFR was measured in 448 type 2 diabetic patients using 51 Cr-EDTA-measured GFR (mGFR) as the reference standard. Bias, precision and accuracy of eGFRcys and eGFRcre were compared. Results The most accurate eGFRcre equation (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), which produced the highest proportion of estimates that were within 30% and 10% of the reference standard (80.7% and 38.0% of samples, respectively) had a bias of 7.1 and precision of 12.0 ml min −1 1.73 m −2 . The calibrated eGFRcys with the highest accuracy (Tan-C), which produced the highest proportion of estimates that were within 30% (78.8%) and within 10% (39.0%) of the reference standard had a bias of −3.5 and precision of 18.0 ml min ) and moderate (mGFR <60 ml min −1 1.73 m −2

Diabetic Nephropathy: New Risk Factors and Improvements in Diagnosis

“…Changes in cystatin-C over time strongly correlate with changes in GFR [78]. However, cystatin-C-based equations for the calculation of GFR are more accurate than the MDRD or CKD-EPI equations [79,80]. However, studies in this topic are few.…”

Effect of Diabetes on the Rat Renal Cortex and the Possible Protective Role of Vitamins C and E

“…They also depended on the immunofluorescence microscopy to reveal deposition of albumin, immunoglobulins, fibrin, and other plasma proteins along the glomerular basement membrane (GBM) in a linear pattern. [38] Examination of the interstitium in diabetic group also revealed cellular infiltration by inflammatory cells. Regarding inflammatory cells, the presence of leukocytic infiltration in diabetic renal tissue was previously reported.…”

Clinical Significance of Cystatin C-Based Estimates of Renal Function in Type 2 Diabetic Patients: Review

“…In this study, the proportion of eGFR results within 10% and 30% of mGFR (defined by 51 Cr-EDTA-measured GFR) was the same when using the MDRD, CKD-EPI and cystatin C-based formulae for the diagnosis of mild and moderate CKD (mGFR <90 and <60 ml/min/1.73 m 2 , respectively). Furthermore, the CKD-EPI creatinine-based equation was found to be the least biased, the most precise and the most accurate equation in type 2 diabetic patients with mGFR ≥90 ml/min/1.73 m 2 [62].…”