The inaccuracy of cystatin C and creatinine-based equations in predicting GFR in orthotopic liver transplant recipients

Boudville, Neil; Salama, Michael; Jeffrey, Gary P.; Ferrari, Paolo

doi:10.1093/ndt/gfp255

Cited by 26 publications

(17 citation statements)

References 29 publications

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“…Some studies have shown that cystatin C may be a better assay for GFR estimation in the setting of cirrhosis [22] and a 2006 study showed that serum cystatin C correlated better with iohexol-based GFR estimates than serum creatinine did [23]. However, a subsequent study in 2009 did not demonstrate improved diagnostic accuracy of cystatin C over serum creatinine in the setting of liver transplantation [24]. Serum cystatin C has been shown to be superior to creatinine as a marker of kidney function in chronic kidney disease [25].…”

Section: Discussionmentioning

confidence: 99%

Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation

et al. 2013

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BackgroundAKI is common following liver transplantation and is associated with significant morbidity and mortality. Biomarkers of AKI have not been well established in this setting but are needed to help guide patient care and facilitate development of novel therapeutics.MethodsSerum creatinine, cystatin C, IL-6, and IL-8 and urine IL-18, NGAL, IL-6, and IL-8 were measured before and within 24 hours after liver transplantation in 40 patients. AKI was defined as a ≥50% sustained increase in creatinine above pre-operative values occurring within 24 hours of transplantation and persisting for at least 24 hours.ResultsSeven patients met criteria for AKI (17.5%), with mean creatinines of 0.81 mg/dL pre-operatively and 1.75 mg/dL post-operatively. While pre-operative biomarker levels in patients with AKI were similar to those in patients without AKI, differences were seen between the groups with regard to median post-operative serum IL-8 (pg/mL) (242.48 vs. 82.37, p = 0.0463) and urine NGAL (ng/mL) (386.86 vs. 24.31, p = 0.0039), IL-6 (pg/mL) (52 vs. 7.29, p=0.0532), IL-8 (pg/mL) (14.3 vs. 0, p = 0.0224), and IL-18 (pg/mL) (883.09 vs. 0, p = 0.0449). The areas under receiver operating characteristic (ROC) curves were 0.749 for urine IL-18, 0.833 for urine NGAL, 0.745 for urine IL-6, 0.682 for serum IL-6, 0.773 for urine IL-8, and 0.742 for serum IL-8. Post-operative cystatin C was not significantly different between AKI and no AKI groups.ConclusionSerum IL-8 and urine IL-18, NGAL, IL-6, and IL-8 are elevated in AKI within the first 24 hours following liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation

et al. 2013

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“…Therefore, we performed the IC test to accurately measure renal function of the included patients. SCr‐based equations have been proven to overestimate GFR in patients after OLT [11,14,18,21,32,34]. CysC is not influenced by many of the factors that usually affect sCr in OLT recipients.…”

Section: Discussionmentioning

confidence: 99%

The assessment of GFR after orthotopic liver transplantation using cystatin C and creatinine-based equations

Wagner¹,

Kniepeiss²,

Stiegler³

et al. 2012

Transplant International

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The measurement of kidney function after orthotopic liver transplantation (OLT) is still a clinical challenge. Cystatin C (CysC) has been proposed as a more accurate marker of renal function than serum creatinine (sCr). The aim of this study was to evaluate sCr‐ and CysC‐based equations including the Chronic kidney disease (CKD)‐EPI to determine renal function in liver transplant recipients. CysC and sCr were measured in 49 patients 24 months after OLT. The glomerular filtration rate (GFR) was calculated using the MDRD 4, the Cockroft‐Gault, Hoek, Larsson, and the CKD‐EPI equations based on sCr and/or CysC. As reference method, inulin clearance (IC) was estimated. Bias, precision, and accuracy of each equation were assessed and compared with respect to IC. Forty‐five percent had a GFR < 60 ml/min/1.73 m2 according to the IC. The Larsson, the Hoek and the CKD‐EPI‐CysC formula identified the highest percentage of patients with CKD correctly (88%, 88%, and 84%, respectively). The sCr‐based equations showed less bias than CysC‐based formulas with a similar precision. All CysC‐based equations were superior as compared with sCr‐based equations in the assessment of renal function in patients with an IC < 60 ml/min/1.73 m2.

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“…Ha 51 Cr-EDTAval mért GFR-rel történt az összehasonlítás, egyes tanulmányok szerint a cisztatin-C-vel meghatározott eGFR volt a valósabb, míg mások szerint a CKDEPIképlet használatával a kreatininnel [21,22,23]. Volt olyan közlemény, amely szerint májtranszplantált betegcsoportban nem volt különbség köztük [24]. Volt olyan, ami szerint ADPKD-ben szenvedő betegek kapcsán együttes mérésük adta a legjobb eredményt [25].…”

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Comparison of seven estimated glomerular filtration rate equations in kidney patients

Kovács

Sárváry

Remport³

2013

Orvosi Hetilap

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Bevezetés: Krónikus vesebetegségben elengedhetetlen a glomerulusfi ltrációs ráta ismerete, mivel annak mértéke határozza meg a stádiumokat, és iránymutató a kezelés szempontjából. Célkitűzés: A szerzők két, a standardizált kreatininen, valamint öt immunturbidimetriás cisztatin-C-meghatározáson alapuló becsült glomerulusfi ltrációs ráta egyenletét vizsgálták. Módszer: Az analitok és az egyenletek eloszlását, kapcsolataikat, a becsült glomerulusfi ltrációs ráták közötti különbségeket és stádiumbesorolásaikat tanulmányozták. Eredmények: A cisztatin-C-képletek több beteget soroltak az 1-es stádiumba, míg a kreatinines képletek a 2-es, 3-as és 4-esbe. Az 5. stádiumba a Grubb1-, Grubb2-és Larsson-képletek több, míg a Tan-és Sjöström-képletek kevesebb beteget soroltak, mint a kreatinines képletek. Legjobban a Grubb1-és Grubb2-egyenletek stádiumbesorolásai hasonlítottak egymásra. A 3-5. stádiumok legritkábban a Sjöström-képlet esetében fordultak elő. Következtetések: A különböző képletekkel számolt becsült glomerulusfi ltrációs ráták szignifi kánsan befolyásolhatják a stádiumbeosztást, így a betegek kezelését és kilátásaik becslését is. Orv. Hetil., 2013, 154, 415-425. Kulcsszavak: kreatinin, cisztatin-C, becsült glomerulusfi ltrációs ráta, krónikus vesebetegség Comparison of seven estimated glomerular fi ltration rate equations in kidney patientsIntroduction: The degree of glomerular fi ltration rate determines the stages of chronic renal disease and, therefore, knowledge on its estimation is essential. Aims: Two standardized creatinine based estimated glomerular fi ltration rate equations and fi ve equations based on the immunoturbidimetric determination of cystatin C were compared. Methods: The distribution of the analytes and the equations, their relations, as well as the differences among the estimated glomerular fi ltration rates and their chronic kidney disease stages assignments were studied. Results: The equations based on cystatin C classifi ed more patient into stage 1, while the creatinine based ones more into stages 2, 3 and 4. The equations published as Grubb1, Grubb2 and Larsson classifi ed more patients while the equations created by Tan and Sjöström classifi ed fewer into stage 5 compared to the creatinine based equations. The equations of Grubb1 and Grubb2 resulted in the most similar stage assignment. The occurence of stages between 3 and 5 was the lowest using the equation of Sjöström. Conclusions: The different equations for the estimation of glomerular fi ltration rate modify signifi cantly the chronic kidney disease stage assignment which may have an infl uence on the treatment and outcome measures of the patients. Orv. Hetil., 2013, 154, 415-425.

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The inaccuracy of cystatin C and creatinine-based equations in predicting GFR in orthotopic liver transplant recipients

Abstract: Therefore, the degree of inaccuracy in cystatin C- and creatinine-based predictive equations brings into question their clinical utility in OLT recipients. We have no evidence that cystatin C is superior to creatinine in this population.

Cited by 26 publications

References 29 publications

Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation

Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation

The assessment of GFR after orthotopic liver transplantation using cystatin C and creatinine-based equations

Comparison of seven estimated glomerular filtration rate equations in kidney patients

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