Performance of chronic kidney disease epidemiology collaboration creatinine-cystatin C equation for estimating kidney function in cirrhosis

Abstract

Conventional creatinine-based glomerular filtration rate (GFR) equations are insufficiently accurate for estimating GFR in cirrhosis. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently proposed an equation to estimate GFR in subjects without cirrhosis using both serum creatinine and cystatin C levels. Performance of the new CKD-EPI creatinine-cystatin C equation (2012) was superior to previous creatinine- or cystatin C-based GFR equations. To evaluate the performance of the CKD-EPI creatinine-cystatin C equation in subjects with cirrhosis, we compared it to GFR measured by non-radiolabeled iothalamate plasma clearance (mGFR) in 72 subjects with cirrhosis. We compared the “bias”, “precision” and “accuracy” of the new CKD-EPI creatinine-cystatin C equation to that of 24-hour urinary creatinine clearance (CrCl), Cockcroft-Gault (CG) and previously reported creatinine- and/or cystatin C-based GFR-estimating equations. Accuracy of CKD-EPI creatinine-cystatin C equation as quantified by root mean squared error of difference scores [differences between mGFR and estimated GFR (eGFR) or between mGFR and CrCl, or between mGFR and CG equation for each subject] (RMSE=23.56) was significantly better than that of CrCl (37.69, P=0.001), CG (RMSE=36.12, P=0.002) and GFR-estimating equations based on cystatin C only. Its accuracy as quantified by percentage of eGFRs that differed by greater than 30% with respect to mGFR was significantly better compared to CrCl (P=0.024), CG (P=0.0001), 4-variable MDRD (P=0.027) and CKD-EPI creatinine 2009 (P=0.012) equations. However, for 23.61% of the subjects, GFR estimated by CKD-EPI creatinine-cystatin C equation differed from the mGFR by more than 30%. CONCLUSIONS The diagnostic performance of CKD-EPI creatinine-cystatin C equation (2012) in patients with cirrhosis was superior to conventional equations in clinical practice for estimating GFR. However, its diagnostic performance was substantially worse than reported in subjects without cirrhosis.

Performance of the estimated glomerular filtration rate creatinine and cystatin C based equations in Thai patients with chronic glomerulonephritis

“…17 Using these equations in children, young adults, the elderly, and people with cirrhosis and HIV also confirmed the high diagnostic performance. [18][19][20][21] With our results, we can probably conclude that the CKD-EPI-creatinine-cystatin C can be used reliably in CGN patients.…”

Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to 99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis

“…In a limited number of studies in patients with cirrhosis, the CysC equations tend to show better results than methods based solely on SCr. However, the published performance of the equations is variable, creating uncertainty as to whether these equations may obviate the need for more accurate methods for measuring GFR in cirrhotics (11)(12)(13)(14)(15).…”

Reevaluation of Serum Carnitine Status in Patients with Liver Cirrhosis

“…Recent reports have suggested that serum Cystatin C, which is not influenced by the muscle volume, has been recommended to calculate the eGFR even in LC patients. [26][27][28] Therefore, our data suggest that the use of only serum CA levels cannot precisely estimate secondary CA deficiency status, even in LC patients with mild renal dysfunction.…”