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Published on: April 13, 2021
KDIGO Guidelines and Kidney Transplantation: Is the Cystatin-C Based Recommendation Relevant?
I Masson1, N Maillard1, E Cavalier2
1Renal Laboratory and Department of Nephrology-Dialysis-Transplantation, University Jean Monnet, CHU Hôpital Nord, Saint-Etienne, France.
Insights
The KDIGO guidelines
Area of Science:
- Nephrology
- Transplantation Medicine
- Diagnostic Strategies
Background:
- Chronic kidney disease (CKD) diagnosis relies on estimated glomerular filtration rate (GFR).
- KDIGO guidelines suggest a two-step approach for CKD diagnosis using creatinine-based (eGFRcreat) and cystatin C-based (eGFRcys/eGFRcreat-cys) equations.
- The applicability of this strategy to kidney transplant recipients (KTR) requires investigation.
Purpose of the Study:
- To evaluate the KDIGO guidelines' two-step diagnostic strategy for CKD in kidney transplant recipients (KTR).
- To assess the accuracy of cystatin C-based equations in confirming decreased GFR in KTR compared to measured GFR.
Main Methods:
- A simulation study was conducted on 670 KTR with available measured GFR.
- CKD detection was simulated using the KDIGO two-step approach versus the conventional creatinine-based equation.
- Analysis focused on patients with eGFRcreat between 45-59 mL/min/1.73 m² without albuminuria.
Main Results:
- The conventional approach misclassified 23% of patients with eGFRcreat 45-59 mL/min/1.73 m² as having CKD when their measured GFR exceeded 60 mL/min/1.73 m².
- Applying the KDIGO strategy, 138 KTR were confirmed with eGFRcreat-cys below 60 mL/min/1.73 m².
- However, 21% of these patients were still misclassified when compared to measured GFR.
Conclusions:
- The KDIGO guidelines' two-step diagnostic strategy, utilizing cystatin C, does not reliably confirm stage 3A CKD in kidney transplant recipients.
- Cystatin C is not recommended as a confirmatory test for stage 3A CKD in KTR due to misclassification rates.
- Further research is needed to refine CKD diagnostic criteria for kidney transplant recipients.
Abstract:
The KDIGO guidelines propose a new approach to diagnose chronic kidney disease (CKD) based on estimated glomerular filtration rate (GFR). In patients with a GFR value comprised between 45 and 59 mL/min/1.73 m(2) as estimated by the CKD-EPI creatinine equation (eGFRcreat ), it is suggested to confirm the diagnosis with a second estimation using the CKD-EPI cystatin C-based equations (eGFRcys /eGFRcreat-cys) . We sought to determine whether this new diagnostic strategy might extend to kidney transplant recipients (KTR) and help to identify those with decreased GFR. In 670 KTR for whom a measured GFR was available, we simulated the detection of CKD using the two-steps approach recommended by the guidelines in comparison to the conventional approach relying on creatinine equation. One hundred forty-five patients with no albuminuria had eGFRcreat between 45 and 59 mL/min/1.73 m(2) . Among them, 23% had inulin clearance over 60 mL/min/1.73 m(2) and were thus incorrectly classified as CKD patients. When applying the Kidney Disease: Improving Global Outcomes (KDIGO) strategy, 138 patients were confirmed as having a GFR below 60 mL/min with eGFRcreat-cys . However, 21% of them were misclassified in reference to measured GFR. Our data do no not support the use of cystatin C as a confirmatory test of stage 3 A CKD in KTR.
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