Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study

Elizabeth L M Barr, Louise J. Maple-Brown, Federica Barzi, Jaquelyne T. Hughes, George Jerums, Elif I. Ekinci, Andrew G. Ellis, Graham R D Jones, Paul D. Lawton, Cherian Sajiv, Sandawana W. Majoni, Alex D H Brown, Wendy E. Hoy, Kerin O'Dea, Alan Cass, Richard J. MacIsaac

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)301-308
Number of pages8
JournalClinical Biochemistry
Issue number6
Early online date25 Nov 2016
Publication statusPublished - 6 Apr 2017


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