Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C?

Iacomelli, Iacopo; Giordano, A.; Rivasi, Giulia; Rafanelli, Martina; Tortù, Virginia; Cartei, Alessandro; Rostagno, Carlo; Bari, Mauro Di; Marchionni, Niccolò; Mossello, Enrico; Ungar, Andrea

doi:10.1016/j.ejim.2020.06.016

Cited by 14 publications

(15 citation statements)

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“…In our study, the SI was a good predictor of postoperative walking ability, even when patients were able to walk independently. Moreover, a recent study reported that the glomerular filtration rate estimated from serum creatinine was overestimated in patients with HF and decreased skeletal muscle mass 17 . The estimated glomerular filtration rate is important for determining the required antibiotic dose and dosage schedule.…”

Section: Discussionmentioning

confidence: 99%

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Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture

Okubo

Yonetani

Tanaka

et al. 2022

J cachexia sarcopenia muscle

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Background The sarcopenia index (SI), calculated as the ratio of serum creatinine to cystatin C levels, reflects skeletal muscle mass and strength. Patients with hip fracture (HF) and sarcopenia have poor functional outcomes, and many require long‐term care after surgery. We hypothesized that the SI can predict preoperative and early postoperative functional outcomes. Methods Preoperative serum creatinine and cystatin C were measured to calculate the SI for patients with surgically treated HF (n = 130, mean age: 87.8 ± 6.9 years). Walking ability before and 2 weeks after surgery was assessed, and patients were dichotomized into independent and assistance groups. To assess the validity of the SI, we examined its correlation with the quality [computed tomography (CT) value] and quantity (cross‐sectional area) of the muscles around the hip on the non‐operated side, which were preoperatively measured using CT. Receiver operating characteristic (ROC) analysis was performed to evaluate the prognostic value of the SI. Results The SI of the preoperative independent (n = 77) and assistance groups (n = 53) significantly differed (70.2 ± 12.4 and 60.1 ± 9.8, respectively, P < 0.000001). At 2 weeks after surgery, the SI was significantly higher in the independent group (n = 31, 73.0 ± 14.9) than in the assistance group (n = 99, 64.0 ± 10.7, P = 0.0003). In the preoperative independent group, 28 could walk independently after surgery (SI: 74.8 ± 14.0) while 49 required assistance (SI: 67.7 ± 10.6, P = 0.01). For patients with femoral neck fracture (FNF), the SIs were significantly higher in the postoperative independent group (78.6 ± 15.7) than in the postoperative assistance group (63.2 ± 10.9, P = 0.002). Logistic regression analysis showed that the odds ratio (95% confidence interval) of the SI for postoperative walking ability was 0.95 (0.91–0.99, P = 0.03). The correlations of SIs with CT values and cross‐sectional areas were as follows: iliopsoas at the apex of the femoral head, r = 0.40, P < 0.001 and r = 0.49, P < 0.001, respectively; rectus femoris at the level of the lessor trochanter, r = 0.26, P = 0.007 and r = 0.37, P < 0.001, respectively. ROC analysis for predicting postoperative walking ability in preoperative independent patients with HF and FNF revealed areas under the curve (95% confidence interval) of 0.63 (0.50–0.76) and 0.80 (0.65–0.96), respectively. Conclusions In patients with HF, the SI correlated with preoperative walking ability and could predict postoperative walking ability. Among patients who could walk independently before surgery, those with high SIs could walk independently early in the postoperative period. The SI is beneficial for estimating walking ability in patients with HF.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the ratio of serum creatinine to cystatin C reflects skeletal muscle mass 14 . However, there are few studies on the use of the SI in patients with HF 17,18 . In particular, there are no studies on functional outcome prediction using the SI in these patients.…”

Section: Introductionmentioning

confidence: 99%

Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture

Okubo

Yonetani

Tanaka

et al. 2022

J cachexia sarcopenia muscle

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“…Interestingly, patients with moderate CKD and sarcopenia had a greater mortality compared to patients with severe CKD and mild or no cognitive impairment (node 13). This counterintuitive finding may be due to the biased estimation of eGFR in sarcopenic patients compared to individual with physiological muscle function; low muscle mass markedly influences serum creatinine levels, so that falsely higher eGFR may result from inappropriately low serum creatinine levels due to sarcopenia [38]. Consequently, these findings suggest the need to use different risk thresholds of eGFR in patients with sarcopenia, since higher eGFR may lead to an underestimation of prognostic risk among older patients with sarcopenia.…”

Section: Discussionmentioning

confidence: 99%

“…At this regard, screening of physical performance and diagnosis of sarcopenia may be useful to recognize patients undiagnosed CKD because of falsely low creatinine due to sarcopenia. Other measures of kidney function not influenced by reduced muscle mass, including cystatin C [38], β-trace protein or β2-microglobulin [39], may be useful in this kind of patients and are worth of testing. Additionally, our findings also confirm that eGFR value at which the risk increases may be lower among older patients compared to younger ones [11,40].…”

Section: Discussionmentioning

confidence: 99%

Prognostic interplay of kidney function with sarcopenia, anemia, disability and cognitive impairment. The GLISTEN study

Soraci

Corica

Corsonello

et al. 2021

European Journal of Internal Medicine

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Background: Interactions between chronic kidney disease (CKD) and several comorbidities may potentially affect prognosis of older hospitalized patients. This study aims at evaluating the prognostic interactions between estimated glomerular filtration rate (eGFR), anemia, sarcopenia, functional and cognitive dysfunction, and 3year mortality among older patients discharged from acute care hospitals. Methods: Our series consisted of 504 older adults enrolled in a multicenter observational study carried out in twelve Acute Geriatric and Internal Medicine wards throughout Italy. CKD was defined as an eGFR< 60 ml/min/ 1.73 m 2 . Anemia, Short Portable Status Mental Questionnaire (SPMSQ), Basic Activities of Daily Living (BADL), sarcopenia, and Charlson index were considered in the analysis. 3-year survival was investigated by Cox regression and prognostic interactions among study variables were assessed by survival tree analysis. Accuracy of different survival models was investigated by C-index. Results: eGFR < 30 mL/min/1.73 m 2 , anemia, sarcopenia, SPMSQ ≥ 5, and impairment in 1 or more BADL were significantly associated with mortality. Survival tree analysis showed that patients with eGFR < 35.32 ml/min/ 1.73 m 2 and SPMSQ ≥ 5 had the highest risk of mortality [hazard ratio (HR): 5.49, 95%CI: 3.04-9.94] followed by those with eGFR < 35.32 ml/min/1.73 m 2 , hemoglobin < 11.95 g/dL and SPMSQ < 5 (HR:3.65; 95%CI: 2.21-6.02) and those with eGFR 35.32-47.99 ml/min/1.73 m 2 and sarcopenia (HR:3.65; 95%CI: 1.99-6.69). Survival tree leaf node membership had good accuracy in predicting the study outcome (C-index: 0.73, 95%

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“…Serum Cys-C concentration appears to be independent of muscular mass, gender, age, nutritional status and chronic diseases. It is recommended as a more precise marker than creatinine in estimating GFR, especially in individuals with mild kidney injury 9 and in some clinical conditions such as hepatic cirrhosis, diabetes mellitus, kidney transplant recipients and in the elderly [10][11][12][13] . However, studies in specific groups such as nephrotic syndrome (NS) are insufficient.…”

Section: Introductionmentioning

confidence: 99%

Comparison of creatinine, cystatin, CKD-EPI cystatin C, CKD-EPI creatinine and MDRD equations in estimating glomerular filtration rate in patients with nephrotic syndrome

Koçak¹,

Kayalar²

2021

Cumhuriyet Medical Journal

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It's recommended to use equations such as Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) by using creatinine level in estimating glomerular filtration rate (GFR). Here, we aimed to compare serum cystatin-C (Cys-C) and Cys-C based equations with creatinine and creatinine based equations in patients with chronic kidney disease (CKD) and nephrotic syndrome (NS). Method: A total of 142 patients with CKD (30 with NS and 112 without NS) followed in the nephrology outpatient clinic were included into the study. The patients were divided into two groups as NS (n=30) and non-NS (n=112). Results: Out of 142 patients, 74 (52.1%) were male. Mean age of the patients was 51.94 ± 14.23 years (17-80). There was no significant difference in terms of age, gender and diabetes prevalence rates between the patients with NS and non-NS (p>0.05). Proteinuria was 6300.77 ± 3192.47 grams in the NS group and 1112.09 ±1004.36 grams in the non-NS group (p=0.001). Total cholesterol and LDL values were found to be significantly higher in patients with NS (p=0.033 and p=0.017, respectively). While there was no difference in serum creatinine level between the two groups, the Cys-C value in the NS group was found to be significantly higher than those of non-NS group (2.44 ± 0.94 vs 2.00 ± 0.99; p=0.014). CKD-EPI-CysC GFR and CKD-EPI Cr-CysC values were found to be significantly lower in the NS group than in the non-NS group (p=0.025, p=0.042, respectively). No significant difference was found between the two groups in CKD-EPI-Cr, MDRD formula and creatinine clearance. Conclusions: Formulas based on alternative markers such as Cys-C may be more advantageous for the correct estimation of GFR. In this study, we showed that CKD-EPI-CysC and CKD-EPI Cr-CysC are better in detecting CKD than others in the evaluation of renal functions in NS.

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Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C?

Cited by 14 publications

References 39 publications

Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture

Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture

Prognostic interplay of kidney function with sarcopenia, anemia, disability and cognitive impairment. The GLISTEN study

Comparison of creatinine, cystatin, CKD-EPI cystatin C, CKD-EPI creatinine and MDRD equations in estimating glomerular filtration rate in patients with nephrotic syndrome

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