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[Use cystatin C-based GFR-estimating equations].

Anders Grubb1, Anders Christensson2, Mårten Segelmark3

  • 1professor, institutionen för laboratoriemedicin, Skånes universitetssjukhus, Lund.

Lakartidningen
|January 24, 2022
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Summary

Glomerular filtration rate (GFR) estimation using cystatin C is recommended over creatinine-based equations. Cystatin C equations avoid using "race" terms, which are sociological, not biological, and impact creatinine levels due to muscle mass differences.

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Area of Science:

  • Nephrology
  • Clinical Chemistry
  • Biomarkers

Background:

  • Glomerular filtration rate (GFR) is a key indicator of kidney function.
  • Current GFR estimation relies on creatinine-based or cystatin C-based equations.
  • Creatinine-based equations incorporate "race" adjustments due to population differences in muscle mass.

Purpose of the Study:

  • To highlight the limitations of race-based adjustments in GFR estimation.
  • To advocate for the adoption of cystatin C-based GFR-estimating equations.
  • To emphasize the sociological nature of "race" versus biological markers.

Main Methods:

  • Review of international studies and guidelines on GFR estimation.
  • Analysis of factors influencing creatinine and cystatin C levels.
  • Comparison of race-adjusted creatinine equations with cystatin C equations.

Main Results:

  • "Race" is a sociological construct, not a biological determinant of GFR.
  • Average muscle mass variations between populations affect creatinine levels.
  • Cystatin C levels are not influenced by muscle mass, making it a more universal marker.

Conclusions:

  • International studies strongly recommend cystatin C-based GFR-estimating equations.
  • Eliminating "race" terms improves the accuracy and equity of GFR estimation.
  • Transitioning to cystatin C offers a more precise and biologically sound approach to assessing kidney function.