TY - JOUR
T1 - Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians
T2 - The eGFR Study
AU - Barr, Elizabeth L M
AU - Maple-Brown, Louise J.
AU - Barzi, Federica
AU - Hughes, Jaquelyne T.
AU - Jerums, George
AU - Ekinci, Elif I.
AU - Ellis, Andrew G.
AU - Jones, Graham R D
AU - Lawton, Paul D.
AU - Sajiv, Cherian
AU - Majoni, Sandawana W.
AU - Brown, Alex D H
AU - Hoy, Wendy E.
AU - O'Dea, Kerin
AU - Cass, Alan
AU - MacIsaac, Richard J.
PY - 2017/4/6
Y1 - 2017/4/6
N2 - Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Methods: Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC + cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4. h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Results: Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m2; 95% CI 13.3-16.4, p <0.001) and eGFRcysC+cr (10.3; 8.8-11.5, p <0.001) compared to eGFRcr (5.4; 3.0-7.2). Accuracy was lower for eGFRcysC (80.3%; 76.7-83.5, p <0.001) but not for eGFRcysC+cr (91.9; 89.3-94.0, p =0.29) compared to eGFRcr (90.0; 87.2-92.4). Precision was comparable for all equations. The performance of eGFRcysC deteriorated across increasing levels of c-reactive protein. Conclusion: Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians.
AB - Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Methods: Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC + cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4. h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Results: Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m2; 95% CI 13.3-16.4, p <0.001) and eGFRcysC+cr (10.3; 8.8-11.5, p <0.001) compared to eGFRcr (5.4; 3.0-7.2). Accuracy was lower for eGFRcysC (80.3%; 76.7-83.5, p <0.001) but not for eGFRcysC+cr (91.9; 89.3-94.0, p =0.29) compared to eGFRcr (90.0; 87.2-92.4). Precision was comparable for all equations. The performance of eGFRcysC deteriorated across increasing levels of c-reactive protein. Conclusion: Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians.
KW - CKD-EPI equation
KW - Creatinine
KW - Cystatin C
KW - GFR
KW - Indigenous
UR - http://www.scopus.com/inward/record.url?scp=85007492118&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiochem.2016.11.024
DO - 10.1016/j.clinbiochem.2016.11.024
M3 - Article
C2 - 27894952
AN - SCOPUS:85007492118
SN - 0009-9120
VL - 50
SP - 301
EP - 308
JO - Clinical Biochemistry
JF - Clinical Biochemistry
IS - 6
ER -
