Journal Article

Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients

U. Pöge, T. Gerhardt, B. Stoffel-Wagner, H. U. Klehr, T. Sauerbruch and R. P. Woitas

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 21, issue 3, pages 660-664
Published in print March 2006 | ISSN: 0931-0509
Published online December 2005 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfi305
Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients

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Background. Plasma creatinine and creatinine clearance are of limited value for the estimation of renal function in cirrhotics. In these patients, cystatin C (Cys C) has been proposed as an alternative marker of glomerular filtration rate (GFR) and Cys C-based equations for calculation of GFR have been developed in non-cirrhotic patient cohorts.

Methods. We retrospectively analyzed correlation, bias, precision and accuracy of two Cys C-based formulae (Larsson and Hoek) for GFR estimation in comparison with two creatinine-based equations (Cockroft & Gault and MDRD). The Cys C was determined by an immunonephelometric method. The GFR was measured by means of inulin clearance in 44 consecutive patients with liver cirrhosis.

Results. On average, inulin clearance was 28.3 (95% CI: 29.2–41.3 ml/min/1.73 m2). Creatinine as well as Cys C-based equations overestimated the true GFR by 105–154%. However, Cys C-based equations showed significantly lower bias and higher precision than the creatinine-based formulae. Correlation and accuracy tended to be better with the Hoek and Larsson equation than with the Cockroft & Gault or MDRD formulae. Hoek and Larsson equations showed a similar diagnostic performance in all statistical procedures.

Conclusion. Our data suggest a significant improvement of GFR estimation in liver cirrhotics by means of the Cys C-based Hoek and Larsson formulae. However, all estimates remain a crude approximation of true GFR and thus cannot replace gold standard methods.

Keywords: accuracy; cystatin C; equations; glomerular filtration rate; inulin clearance; liver cirrhosis

Journal Article.  3130 words.  Illustrated.

Subjects: Nephrology

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