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Published on: May 10, 2013
Calculation of glomerular filtration rate based on cystatin C in cirrhotic patients
U Pöge1, T Gerhardt, B Stoffel-Wagner
1Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, D 53105 Bonn, Germany. u.poege@uni-bonn.de
Insights
Cystatin C (Cys C) equations improve glomerular filtration rate (GFR) estimation in liver cirrhosis patients compared to creatinine. While still approximations, Cys C formulas offer better accuracy for assessing renal function in this population.
Area of Science:
- Nephrology
- Hepatology
- Clinical Chemistry
Background:
- Plasma creatinine and creatinine clearance are unreliable for estimating renal function in liver cirrhosis patients.
- Cystatin C (Cys C) is a potential alternative marker for glomerular filtration rate (GFR) in this population.
- Existing Cys C-based GFR equations were developed in non-cirrhotic cohorts.
Purpose of the Study:
- To evaluate the accuracy, bias, precision, and correlation of Cys C-based GFR estimation formulas (Larsson and Hoek) in patients with liver cirrhosis.
- To compare the performance of Cys C-based equations against traditional creatinine-based equations (Cockroft & Gault and MDRD).
Main Methods:
- Retrospective analysis of GFR estimation using inulin clearance as the gold standard in 44 liver cirrhosis patients.
- Measurement of Cys C using an immunonephelometric method.
- Comparison of two Cys C-based (Larsson, Hoek) and two creatinine-based (Cockroft & Gault, MDRD) equations.
Main Results:
- All tested equations (creatinine and Cys C-based) overestimated the true GFR (inulin clearance).
- Cys C-based equations demonstrated significantly lower bias and higher precision than creatinine-based equations.
- The Hoek and Larsson equations showed comparable and improved correlation and accuracy over Cockroft & Gault and MDRD.
Conclusions:
- The Cys C-based Hoek and Larsson formulae represent a significant improvement for GFR estimation in liver cirrhosis patients.
- Despite improvements, all tested equations provide only a crude approximation of true GFR and do not replace gold standard methods.
Background:
Plasma creatinine and creatinine clearance are of limited value for the estimation of renal function in cirrhotics. In these patients, cystatin C (Cys C) has been proposed as an alternative marker of glomerular filtration rate (GFR) and Cys C-based equations for calculation of GFR have been developed in non-cirrhotic patient cohorts.
Methods:
We retrospectively analyzed correlation, bias, precision and accuracy of two Cys C-based formulae (Larsson and Hoek) for GFR estimation in comparison with two creatinine-based equations (Cockroft & Gault and MDRD). The Cys C was determined by an immunonephelometric method. The GFR was measured by means of inulin clearance in 44 consecutive patients with liver cirrhosis.
Results:
On average, inulin clearance was 28.3 (95% CI: 29.2-41.3 ml/min/1.73 m2). Creatinine as well as Cys C-based equations overestimated the true GFR by 105-154%. However, Cys C-based equations showed significantly lower bias and higher precision than the creatinine-based formulae. Correlation and accuracy tended to be better with the Hoek and Larsson equation than with the Cockroft & Gault or MDRD formulae. Hoek and Larsson equations showed a similar diagnostic performance in all statistical procedures.
Conclusion:
Our data suggest a significant improvement of GFR estimation in liver cirrhotics by means of the Cys C-based Hoek and Larsson formulae. However, all estimates remain a crude approximation of true GFR and thus cannot replace gold standard methods.
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