Discordance Between Creatinine-Based and Cystatin C-Based Estimated GFR: Interpretation According to Performance Compared to Measured GFR.

Autor:	Wang Y; Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA., Adingwupu OM; Division of Nephrology, Tufts Medical Center, Boston, MA., Shlipak MG; Kidney Health Research Collaborative, San Francisco Veterans Affair Medical Center and University of California, San Francisco, CA., Doria A; Section on Genetics & Epidemiology, Joslin Diabetes Center, and the Department of Medicine, Harvard Medical School, Boston, MA., Estrella MM; Division of Nephrology, Department of Medicine, San Francisco VA Health Care System and University of California, San Francisco, CA., Froissart M; Clinical Trial Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Gudnason V; Faculty of Medicine, University of Iceland, Reykjavik, and the Icelandic Heart Association, Kopavogur, Iceland., Grubb A; Department of Clinical Chemistry and Pharmacology, Institute of Laboratory Medicine, Lund University, Sweden., Kalil R; Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD., Mauer M; Divisions of Pediatric and Adult Nephrology, University of Minnesota, Minneapolis, MN., Rossing P; Steno Diabetes Center Copenhagen and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Seegmiller J; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN., Coresh J; Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD., Levey AS; Division of Nephrology, Tufts Medical Center, Boston, MA., Inker LA; Division of Nephrology, Tufts Medical Center, Boston, MA.
Jazyk:	angličtina
Zdroj:	Kidney medicine [Kidney Med] 2023 Aug 09; Vol. 5 (10), pp. 100710. Date of Electronic Publication: 2023 Aug 09 (Print Publication: 2023).
DOI:	10.1016/j.xkme.2023.100710
Abstrakt:	Rationale & Objective: Use of cystatin C in addition to creatinine to estimate glomerular filtration rate (estimated glomerular filtration rate based on cystatin C [eGFRcys] and estimated glomerular filtration rate based on creatinine [eGFRcr], respectively) is increasing. When eGFRcr and eGFRcys are discordant, it is not known which is more accurate, leading to uncertainty in clinical decision making. Study Design: Cross-sectional analysis. Setting & Participants: Four thousand fifty participants with measured glomerular filtration rate (mGFR) from 12 studies in North America and Europe. Exposures: Serum creatinine and serum cystatin C. Outcomes: Performance of creatinine-based and cystatin C-based glomerular filtration rate estimating equations compared to mGFR. Analytical Approach: We evaluated the accuracy of eGFRcr, eGFRcys, and the combination (eGFRcr-cys) compared to mGFR according to the magnitude of the difference between eGFRcr and eGFRcys (eGFRdiff). We used CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations to estimate glomerular filtration rate. eGFRdiff was defined as eGFRcys minus eGFRcr and categorized as less than -15, -15 to <15, and ≥15 mL/min/1.73 m 2 (negative, concordant, and positive groups, respectively). We compared bias (median of mGFR minus eGFR) and the percentage of eGFR within 30% of mGFR. Results: Thirty percent of participants had discordant eGFRdiff (21.0% and 9.6% negative and positive eGFRdiffs, respectively). In the concordant eGFRdiff group, all equations displayed similar accuracy. In the negative eGFRdiff groups, eGFRcr had a large overestimation of mGFR (-13.4 [-14.5 to -12.2] mL/min/1.73 m 2 ) and eGFRcys had a large underestimation (9.9 [9.1-11.2] mL/min/1.73m 2 ), with opposite results in the positive eGFRdiff group. In both negative and positive eGFRdiff groups, eGFRcr-cys was more accurate than either eGFRcr or eGFRcys. These results were largely consistent across age, sex, race, and body mass index. Limitations: Few participants with major comorbid conditions. Conclusions: Discordant eGFRcr and eGFRcys are common. eGFR using the combination of creatinine and cystatin C provides the most accurate estimates among persons with discordant eGFRcr or eGFRcys. (© 2023 The Authors.)
Databáze:	MEDLINE
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