Cystatin C kidney functional reserve: a simple method to predict outcome in chronic kidney disease
| Autor: | Kylie M. Taylor, Monica Rossleigh, Daniel Christiadi, Zoltan H. Endre, Jonathan Erlich, Grant Luxton, Kate O'brien, Charles Simpson |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology Urology Renal function Kidney Cohort Studies 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Low-protein diet Renal Dialysis medicine Humans 030212 general & internal medicine Cystatin C Renal Insufficiency Chronic Dialysis Transplantation Creatinine biology business.industry Pentetic Acid medicine.disease medicine.anatomical_structure chemistry Nephrology biology.protein business Biomarkers Glomerular Filtration Rate Kidney disease Cohort study |
| Zdroj: | Nephrology Dialysis Transplantation. 37:1118-1124 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfab188 |
| Popis: | Background Kidney functional reserve (KFR), the only clinical kidney stress test, is not routinely measured because the complexity of measurement has limited clinical application. We investigated the utility of plasma cystatin C (CysC) after oral protein loading (PL) to determine KFR in Stages 3 and 4 chronic kidney disease (CKD). Methods Following a 24-h low-protein diet, KFR was measured after oral protein by hourly plasma CysC and compared with simultaneous creatinine clearance (CrCl) and radionuclide 99technetium diethylenetriaminepentaacetatic acid (Tc-99m-DTPA) measured glomerular filtration rate (mGFR) measurement in an observational, single-centre cohort study of adults with CKD Stages 3 and 4. Subjects were followed for 3 years for fast (F) or slow (S) CKD progression, dialysis requirement or death or a combination of major adverse kidney events (MAKEs). Result CysC, CrCl and Tc-99m-DTPA mGFR measurements of KFR in 19 CKD Stage 3 and 21 CKD Stage 4 patients yielded good agreement. KFR was not correlated with baseline kidney function. Eight CKD Stage 3 (42%) and 11 CKD Stage 4 (52%) subjects reached their lowest serum CysC concentration 4 h after PL. CysC KFR and baseline serum creatinine (sCr) predicted death or dialysis or MAKE-F with a respective area under the curve (AUC) of 0.73 [95% confidence interval (CI) 0.48–0.89] and 0.71 (95% CI 0.51–0.84). Including CysC KFR, age, baseline sCr and nadir CysC predicted a decrease in sCr-estimated GFR >1.2 mL/min/year (MAKE-S) with an AUC of 0.89. Conclusions Serial CysC avoided timed urine collection and radionuclide exposure and yielded equivalent estimates of KFR. Serial CysC may facilitate monitoring of KFR in clinical practice. |
| Databáze: | OpenAIRE |
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