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Assessment of glomerular filtration rate in renal transplant patients using serum cystatin C
1Transplantation Institute, West China Hospital, Sichuan University, Chengdu, China 610041.
Insights
Serum cystatin C (SCysC) is a more sensitive marker than serum creatinine (Scr) for detecting early changes in kidney function after transplantation. This study evaluated SCysC in renal transplant patients, finding it superior to Scr in assessing glomerular filtration rate (GFR).
Area of Science:
- Nephrology
- Transplantation Medicine
- Clinical Chemistry
Background:
- Serum cystatin C (SCysC) is a potential alternative marker for estimating glomerular filtration rate (GFR).
- Limited data exist on SCysC's utility in renal transplant recipients, particularly in the early postoperative period.
Purpose of the Study:
- To evaluate the performance of SCysC as a marker of GFR in renal transplant patients.
- To compare SCysC with serum creatinine (Scr) in assessing early changes in allograft function.
Main Methods:
- 39 renal transplant patients were assessed for SCysC and Scr preoperatively and at 1 and 4 weeks post-transplant.
- Glomerular filtration rate was estimated using creatinine clearance (Ccr) calculated via the Cockcroft-Gault formula.
- SCysC was measured using particle-enhanced turbidimetric immunoassay.
Main Results:
- SCysC and Scr levels decreased with improved allograft function.
- SCysC demonstrated strong correlations with Scr (r=0.849-0.940) and Ccr (r=0.857-0.876).
- SCysC showed significantly better correlation with Ccr (r=0.778) than Scr (r=0.553) at Ccr levels of 50-80 mL/min/1.73 m(2).
- SCysC was unaffected by most factors except slight increases with corticosteroids and decreases with cyclosporine (CsA).
- Receiver operating characteristic curve analysis indicated SCysC (AUC=0.964) was more sensitive than Scr (AUC=0.915) for GFR changes.
Conclusions:
- Serum cystatin C is a more sensitive biomarker than serum creatinine for detecting early and moderate GFR deterioration in adult renal transplant recipients.
- While influenced by certain immunosuppressants like prednisolone and CsA, SCysC offers improved GFR assessment in this population.
Aim:
Serum cystatin C (SCysC) has been proposed as a better marker of glomerular filtration rate (GFR) than serum creatinine (Scr). However, few data are available in renal transplant patients, especially, during the early postoperative phase.
Methods:
Thirty-nine renal transplant patients (22 men/17 women) were recruited for determination of SCysC and Scr before operation, at 1 week and at 4 weeks after operation. SCysC was determined by particle-enhanced turbidimetric immunoassay. Creatinine clearance (Ccr) was calculated using the Cockcroft-Gault formula.
Results:
SCysC and Scr levels significantly decreased with the recovery of allograft function. SCysC showed a significant correlation with Scr and Ccr. The relationship between SCysC and Scr showed a positive correlation (r = .849 preoperation, and r = .940 postoperation). The relationship between SCysC and Ccr revealed a negative correlation (r = .857 preoperation, and r = .876 postoperation). At the Ccr level of 50 to 80 mL/min/1.73 m(2), the correlation between SCysC and Ccr (r = .778) was significantly better than that between Scr and Ccr (r = .553; P = .032). The concentration of SCysC was not affected by age, gender, height, body weight, hemoglobin, serum protein, glucose, or mycophenolate mofetil or azathioprine dosage. However, corticosteroids slightly increased the level of SCysC and cyclosporine (CsA) decreased it. The area under the curve of the receiver operating characteristic curve for SCysC and Scr are 0.964 and 0.915, respectively (P < .05).
Conclusion:
Although the concentration may be slightly influenced by prednisolone and CsA, SCysC is more sensitive than Scr to detect early and moderate deterioration of GFR in adult renal transplant recipients.
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