Abstract
We determined the sensitivity, specificity, receiver operating characteristics and correlation between cystatin C (cysC) and two widely used markers of renal function, creatinine clearance and serum creatinine, in 244 patients (84 diabetics, 84 hypertensive and 76 healthy subjects). Renal failure was defined as creatinine clearance of less than either 80 or 60mL/min. Variables were evaluated for two definitions of renal failure and compared between patient groups. Correlation coefficients with cysC were −0.87 for creatinine clearance and 0.92 for creatinine in patients with hypertension; −0.90 for creatinine clearance and 0.97 for creatinine in diabetics; and −0.61 for creatinine clearance and 0.94 for creatinine in the control group. The receiver operating characteristic curves with a cut-off value of 60mL/min were similar for creatinine and cysC, while at 80mL/min they were 0.626 for creatinine and 0.813 for cysC levels. We classified the patients into three groups with respect to creatinine clearance (1, >80mL/min; 2, 60–80mL/min; 3, <60mL/min). Mean creatinine (p<0.0001) and cysC (p<0.0001) levels were significantly different between all the groups. Sensitivity, specificity and predictive values were higher for cysC levels, particularly in diabetics and hypertensive patients. The current study suggests that cysC is preferable for detecting temporal changes in renal function in the early stages of renal insufficiency.
References
1. Bostom AG, Dworkin LD. Cystatin C measurement: improved detection of mild decrements in glomerular filtration rate versus creatinine-based estimates? Am J Kidney Dis 2000; 36: 205–7. 10.1053/ajkd.2000.9199Search in Google Scholar
2. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 1985; 28: 830–8. 10.1038/ki.1985.205Search in Google Scholar
3. Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes. Am J Kidney Dis 2001; 38: 310–6. 10.1053/ajkd.2001.26096Search in Google Scholar
4. DOQI. Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification and stratification. evaluation of laboratory measurements for clinical assessmentof kidney disease. Am J Kidney Dis 2002;39(Suppl 1):S76–9. 10.1053/ajkd.2002.30944Search in Google Scholar
5. Price CP, Finney H. Developments in the assessment of glomerular filtration rate. Clin Chim Acta 2000; 297: 55–66. 10.1016/S0009-8981(00)00233-3Search in Google Scholar
6. Dworkin LD. Serum cystatin C as a marker of glomerular filtration rate. Curr Opin Nephrol Hypertens 2001; 10: 551–3. 10.1097/00041552-200109000-00001Search in Google Scholar PubMed
7. Abrahamson M, Olafsson I, Palsdottir A, Ulvsback M, Lundwall A, Jensson O, et al. Structure and expression of the human cystatin C gene. Biochem J 1990; 268: 287–94. 10.1042/bj2680287Search in Google Scholar PubMed PubMed Central
8. Kazama JJ, Kutsuwada K, Ataka K, Maruyama H, Gejyo F. Serum cystatin C reliably detects renal dysfunction in patients with various renal diseases. Nephron 2002; 91: 13–20. 10.1159/000057599Search in Google Scholar PubMed
9. Joint National Committee on Prevention Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413–46. 10.1001/archinte.157.21.2413Search in Google Scholar PubMed
10. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983; 148: 839–43. 10.1148/radiology.148.3.6878708Search in Google Scholar PubMed
11. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem 1992; 38: 1933–53. 10.1093/clinchem/38.10.1933Search in Google Scholar
12. Randers E, Erlandsen EJ. Serum cystatin C as an endogenous marker of the renal function – a review. Clin Chem Lab Med 1999; 37: 389–95. 10.1515/CCLM.1999.064Search in Google Scholar
13. Herget-Rosenthal S, Trabold S, Pietruck F, Holtmann M, Philipp T, Kribben A. Cystatin C: efficacy as screening test for reduced glomerular filtration rate. Am J Nephrol 2000; 20: 97–102. 10.1159/000013564Search in Google Scholar
14. Narayanan S, Appleton HD. Creatinine: a review. Clin Chem 1980; 26: 1119–26. 10.1093/clinchem/26.8.1119Search in Google Scholar
15. Tenstad O, Roald AB, Grubb Aaukland K. Renal handling of radiolabelled human cystatin C in the rat. Scand J Clin Lab Invest 1996; 56: 409–14. 10.3109/00365519609088795Search in Google Scholar
16. Keevil BG, Kilpatrick ES, Nichols SP, Maylor PW. Biological variation of cystatin C: implications for the assessment of glomerular filtration rate. Clin Chem 1998; 44: 1535–9. 10.1093/clinchem/44.7.1535Search in Google Scholar
17. Filler G, Bokenkamp A, Hofmann W, Le Bricon T, Martinez-Bru C, Grubb A. Cystatin C as a marker of GFR – history, indications, and future research. Clin Biochem 2005; 38: 1–8. 10.1016/j.clinbiochem.2004.09.025Search in Google Scholar
18. Wasen E, Isoaho R, Mattila K, Vahlberg T, Kivela SL, Irjala K. Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C. J Intern Med 2004; 256: 70–8. 10.1111/j.1365-2796.2004.01340.xSearch in Google Scholar
19. Wasen E, Isoaho R, Mattila K, Vahlberg T, Kivela SL, Irjala K. Serum cystatin C in the aged: relationships with health status. Am J Kidney Dis 2003; 42: 36–43. 10.1016/S0272-6386(03)00406-2Search in Google Scholar
20. Harmoinen AP, Kouri TT, Wirta OR, Lehtimaki TJ, Rantalaiho V, Turjanmaa VM, et al. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes. Clin Nephrol 1999; 52: 363–70. Search in Google Scholar
21. Seco ML, Rus A, Sierra M, Caballero M, Borque L. Determination of serum cystatin C in patients with essential hypertension. Nephron 1999; 81: 446–7. 10.1159/000045333Search in Google Scholar PubMed
22. Donadio C, Lucchesi A. Serum cystatin as a marker of glomerular filtration rate. Am J Kidney Dis 2001; 37: 448–51. 10.1053/ajkd.2001.22465Search in Google Scholar
23. Flise D, Ritz E. Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 2001; 37: 79–83. 10.1053/ajkd.2001.20628Search in Google Scholar
24. Coll E, Botey A, Alvarez L, Poch E, Poch E, Quinto L, et al. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000; 36: 29–34. 10.1053/ajkd.2000.8237Search in Google Scholar
25. Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C. Nephrol Dial Transplant 1999; 14: 1991–6. 10.1093/ndt/14.8.1991Search in Google Scholar
26. Dati F, Brand B. Standardization activities for harmonization of test results. Clin Chim Acta 2000; 29: 239–49. 10.1016/S0009-8981(00)00250-3Search in Google Scholar
27. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002; 40: 221–6. 10.1053/ajkd.2002.34487Search in Google Scholar PubMed
©2005 by Walter de Gruyter Berlin New York
