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Title: Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study.
Austin Authors: Barr, Elizabeth Lm;Maple-Brown, Louise J;Barzi, Federica;Hughes, Jaquelyne T;Jerums, George ;Ekinci, Elif I ;Ellis, Andrew G ;Jones, Graham Rd;Lawton, Paul D;Sajiv, Cherian;Majoni, Sandawana W;Brown, Alex Dh;Hoy, Wendy E;O'Dea, Kerin;Cass, Alan;MacIsaac, Richard J
Affiliation: South Australian Health and Medical Research Institute, Adelaide, Australia
Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Menzies School of Health Research, Darwin, Australia
University of Queensland, Brisbane, Australia
University of South Australia, Adelaide, Australia
St Vincent's Hospital Melbourne, Melbourne, Australia
Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Melbourne, Australia
SydPath, St Vincent's Hospital, Sydney, Australia
University of New South Wales, Sydney, Australia
Northern Territory Renal Services, Darwin, Australia
Northern Territory Department of Health, Darwin, Australia
Division of Medicine, Royal Darwin Hospital, Australia
Division of Nephrology, Royal Darwin Hospital, Australia
Issue Date: Apr-2017 2016-11-25
Publication information: Clinical biochemistry 2017; 50(6): 301-308
Abstract: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC+cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m2; 95% CI 13.3-16.4, p<0.001) and eGFRcysC+cr (10.3; 8.8-11.5, p<0.001) compared to eGFRcr (5.4; 3.0-7.2). Accuracy was lower for eGFRcysC (80.3%; 76.7-83.5, p<0.001) but not for eGFRcysC+cr (91.9; 89.3-94.0, p=0.29) compared to eGFRcr (90.0; 87.2-92.4). Precision was comparable for all equations. The performance of eGFRcysC deteriorated across increasing levels of c-reactive protein. Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians.
DOI: 10.1016/j.clinbiochem.2016.11.024
ORCID: 0000-0003-2372-395X
PubMed URL: 27894952
Type: Journal Article
Subjects: CKD-EPI equation
Cystatin C
Appears in Collections:Journal articles

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