Is Cystatin C Useful for the Detection and the Estimation of Low Glomerular Filtration Rate in Heart Transplant Patients?

Abstract

Although previously studied in patients with chronic kidney disease, there is less data for the use of cystatin C and cystatin C-based formulas in heart transplant recipients. The ability of creatinine and cystatin C to detect renal failure (glomerular filtration rate [GFR] below 60 mL/min/1.73 m(2)) in heart transplant patients has been compared. The accuracy and precision of a creatinine-based formula (Modification of Diet in Renal Disease [MDRD]) versus a cystatin C-based formula (Rule's formula) to estimate GFR have also been studied. GFR was measured using the (51)Cr-ethylenediamine tetraacetic acid tracer in 27 patients. There was no significant difference between GFR and the reciprocal of creatinine or cystatin C. Receiver operating characteristic curves for cystatin C and creatinine were similar. Both formulas were well correlated with the GFR. The bias of the cystatin C-based was significantly better than one of the MDRD formula, but the standard deviation appeared better for the MDRD formula (bias of +3.9 mL/min/1.73 m(2) versus +12 mL/min/1.73 m(2) and SD of 8.5 versus 11.6, respectively). Plasma cystatin C has no clear advantage over serum creatinine to detect renal failure in heart transplanted patients.

Lipoprotein Abnormalities Associated with Mild Impairment of Kidney Function in the Multi-Ethnic Study of Atherosclerosis

“…When data on cardiovascular events become available for the MESA cohort, we will be able to evaluate whether lipoprotein abnormalities mediate any association of cystatin C with cardiovascular events. In addition, although some studies report that serum levels of cystatin C more accurately detect mild decrements in renal function compared with creatinine, others do not (48,49). Thus, cystatin C is not universally considered as a reliable marker of renal function in the setting of mild renal impairment, and its usefulness in clinical practice for the assessment of renal function is still in question (48,50).…”

Cystatin C: current position and future prospects

“…At present, these equations appear to offer very limited advantage compared to the MDRD equation, which is based on serum creatinine, age, sex and race, at least for the general population (110-115, 127, 128). These equations also appear to offer limited precision (52,110,113,116,124,129,130). As we shall see below, they could be more useful in certain subpopulations in which creatinine-based equations are particularly inaccurate, as in paediatrics (116,117,124), transplantation (113,115,(131)(132)(133) or oncology (134).…”

“…Nevertheless, the variability of CysC due to muscle mass is far less than for creatinine. The advantage of CysC over creatinine in a patient with reduced muscle mass is therefore still considerable (52)(53)(54)(55). In particular, malnutrition has been shown in children not to affect equations based on CysC concentrations in contrast to the serum creatinine-based Schwartz equation (53).…”

“…In heart transplantation, the Rule equation (115) incorporating CysC significantly increases the accuracy of GFR prediction compared to the MDRD equation (52). Equations based on CysC have also been reported to offer better predictive performance in liver transplantation (131).…”

Exploration de la fonction glomérulaire rénale : estimation du débit de filtration glomérulaire

“…En transplantation cardiaque, l'é quation de Rule et al inté grant la cystatine C permet d'augmenter significativement la justesse de pré diction du DFG par rapport à l'é quation MDRD [84,156]. Une meilleure performance pré dictive des é quations basé es sur la cystatine C a é galement é té rapporté e en transplantation hé patique [95].…”