Estimating Renal Function in the Elderly Malaysian Patients Attending Medical Outpatient Clinic: A Comparison between Creatinine Based and Cystatin-C Based Equations

Article

作者: Tan, Maw Pin ; Elagel, Salma Mohamed Abouzriba ; Ng, Kok Peng ; Lim, Soo Kun ; Jalalonmuhali, Maisarah

Background. To assess the performance of different GFR estimating equations, test the diagnostic value of serum cystatin-C, and compare the applicability of cystatin-C based equation with serum creatinine based equation for estimating GFR (eGFR) in comparison with measured GFR in the elderly Malaysian patients.Methods. A cross-sectional study recruiting volunteered patients 65 years and older attending medical outpatient clinic. 51 chromium EDTA (51Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations using serum creatinine (CKD-EPIcr) as well as serum cystatin-C (CKD-EPIcys) were calculated.Results. A total of 40 patients, 77.5% male, with mean measured GFR41.2±18.9 ml/min/1.73 m2were enrolled. Mean bias was the smallest for 4-MDRD; meanwhile, CKD-EPIcr had the highest precision and accuracy with lower limit of agreement among other equations. CKD-EPIcys equation did not show any improvement in GFR estimation in comparison to CKD-EPIcr and MDRD.Conclusion. The CKD-EPIcr formula appears to be more accurate and correlates better with measured GFR in this cohort of elderly patients.

2017-01-01·Nephron4区 · 医学

An Overview of Errors and Flaws of Estimated GFR versus True GFR in Patients with Diabetes Mellitus

4区 · 医学

Review

作者: Luis-Lima, Sergio ; Porrini, Esteban

The determination of renal function is crucial in patients with type 2 diabetes (T2DM), a population at risk for chronic kidney disease (CKD). Glomerular filtration rate (GFR) can be measured (mGFR) with gold standard methods or estimated (eGFR) with formulas. Since 1957, when Effersoe published the first formula, more than 50 equations have been developed to estimate GFR. In this review, we examined the studies that compared mGFR and eGFR in patients with T2DM to analyze the performance of those formulae in this population. In cross-sectional studies, the average error of eGFR was ±30% of mGFR. Thus, in a patient with mGFR of 60 mL/min, eGFR may vary from 42 to 78 mL/min. Moreover, many patients were misclassified according to CKD stages. Formulas failed to detect glomerular hyperfiltration. In longitudinal studies, eGFR poorly reflected real GFR decline over time. All studies showed that eGFR decline was slower than mGFR decline. Notably, no major improvement in accuracy and precision has been observed since 1957 despite the use of cystatin-c. Thus, formulas are not reliable indicators of GFR in patients with T2DM. In clinical studies, where GFR is the main outcome measure of the study, eGFR should be avoided.

2016-01-01·Clinical Biochemistry3区 · 医学

Cystatin-C levels in healthy children and adolescents: Influence of age, gender, body mass index and blood pressure

3区 · 医学

Article

作者: Drakatos, Antonis ; Garoufi, Anastasia ; Marmarinos, Antonios ; Panagoulia, Adamantia ; Gourgiotis, Dimitrios ; Dimou, Stamatina ; Paraskakis, Irene

OBJECTIVESCystatin-C is considered a more sensitive and specific marker of kidney function than creatinine since it can diagnose patients with earlier-stage of renal dysfunction. The aim of this study is to determine the levels of Cystatin-C in healthy children and adolescents as well as any correlations to age, gender, body-mass index (BMI) and blood pressure (BP).DESIGN AND METHODSCystatin-C was measured in 536 healthy Greek children and adolescents (295 males and 241 females) using a nephelometric immunoassay. Additionally, the age, body mass index and blood pressure was recorded for each subject.RESULTSOverall, the mean serum Cystatin-C level was 0.79 ± 0.10 mg/L. Cystatin-C was found to be statistically significantly lower in females than in males (p < 0.001) as well as in prepubertal children compared to adolescents (p < 0.001). Higher values of Cystatin-C were observed in subjects with increased BMI (p < 0.001). Neither systolic nor diastolic blood pressure was found to significantly affect Cystatin-C levels.CONCLUSIONSThe levels of Cystatin-C were statistically significantly higher in males, compared to age-matched females and also positively correlated with age and BMI.

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