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[Utility of cystatin-C in hospitalized patients. Comparing with different methods of assessing renal function]
Insights
Serum creatinine has limitations for assessing renal function. Cystatin-C offers improved sensitivity for detecting early kidney disease, potentially reducing the need for 24-hour urine collections and improving diagnosis.
Area of Science:
- Nephrology
- Clinical Chemistry
- Biomarkers
Background:
- Serum creatinine is the standard for renal function assessment but has limitations.
- 24-hour creatinine clearance (CLcr), Cockcroft-Gault (C-G), and MDRD formulas are used but can yield differing results, causing clinical confusion.
- Cystatin-C is emerging as a potentially superior marker for renal function evaluation.
Purpose of the Study:
- To compare various renal function assessment methods.
- To evaluate the utility of Cystatin-C in a hospital setting.
- To determine if Cystatin-C can improve the detection of renal alterations.
Main Methods:
- A study included 70 patients (44 male), predominantly with kidney disease and diabetes.
- Measurements included 24-hour creatinine clearance (CLcr), Cockcroft-Gault (C-G) formula, MDRD formula, serum creatinine, and Cystatin-C levels.
- Statistical analysis involved correlation studies and Bland-Altman plots to compare methods.
Main Results:
- Correlations between 1/Creatinine and CLcr, C-G, and MDRD were 0.7735, 0.8269, and 0.9613, respectively (p<0.0001).
- Correlations between 1/Cystatin-C and CLcr, C-G, and MDRD were 0.836, 0.8142, and 0.832, respectively (p<0.0001).
- Cystatin-C demonstrated higher sensitivity (80.4%) than creatinine (44.7% in men) for detecting slight renal alterations.
Conclusions:
- Renal function formulas can reduce the need for urine collections.
- Cystatin-C is a promising alternative to creatinine for assessing renal function, especially for detecting subtle changes.
- Cystatin-C may help identify hidden renal insufficiency missed by creatinine, though further studies are warranted.
Abstract:
Serum creatinine is the most widely use parameter to assessing renal function, even though limitations, some time is necessary measure 24 h creatinine clearance (CLcr), or estimate Cockroft-Gault (C-G) or MDRD formulas. Different methods can offer different results, and cause confusion in clinicians. Using Cystatin-C as new parameter of renal function could suppose an important improvement. The objective of our study was to compare the different methods from renal evaluation and establish the utility of cistatina-C in the hospital area. In the study were included 70 patients (44 men) selected of random way, predominate patients with kidney disease and diabetics, which was made CLcr and calculated C-G and MDRD formulas. The mean age of the patients was 66+/-14 years, mean weight 73+/-17 Kg, creatinine 2,14+/-1,77 mg/dL, cystatin-c 1,77+/-1,18 mg/L, CLcr 54,39+/-36,2 mL/min. The correlation of 1/Crea with the Clcr, C-G and MDRD formulas was respectively: 0,7735, 0.8269 and 0.9613, (p< 0.0001). The correlation of 1/Cist with the Clcr, C-G and MDRD was respectively: 0,836, 0.8142 and 0.832, (p<0,0001). By Bland-Altman graphs the average of the difference between CLcr with CG and MDRD was 2,8 mL/min and -1,5 mL/min respectively. Comparing CG with MDRD was 1,7 mL/min. The average of the observed absolute differences between CLcr with CG and MDRD was 13.5 mL/min and 17.1 mL/min respectively. Between this formulas the average was 12.5 mL/min. Statistically significant differences between the different methods from renal evaluation do not exist (p>0,05). In conclusion, most of the urine collections could be avoided with the use of the formulas. Cystatin-c is far beyond the creatinine, mainly to detect slight renal alteration (sensitivity 80,4% U.S. 44,7% in men) becoming a promising alternative, that could reduce considerably hidden renal insufficiency (non detected by creatinine), although more studies are needed to confirm.
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