Cystatin C-based equations in renal transplantation: moving toward a better glomerular filtration rate prediction?

• Published in: Transplantation Vol. 85; no. 12; p. 1855
• Main Authors: Maillard, Nicolas, Mariat, Christophe, Bonneau, Christine, Mehdi, Manolie, Thibaudin, Lise, Laporte, Silvy, Alamartine, Eric, Chamson, Annette, Berthoux, François
• Format: Journal Article
• Language: English
• Published: United States 27.06.2008
• Subjects: Adult; Aged; Biomarkers - blood; Creatinine - blood; Cystatin C; Cystatins - blood; Female; Glomerular Filtration Rate - physiology; Humans; Inulin - metabolism; Kidney - physiology; Kidney Function Tests; Kidney Transplantation - physiology; Male; Middle Aged; Models, Biological; Predictive Value of Tests
• ISSN: 0041-1337
• DOI: 10.1097/TP.0b013e3181744225

Creatinine-based glomerular filtration rate (GFR) estimators perform poorly in renal transplant recipients. Cystatin C might be a better alternative to serum creatinine in assessing renal graft function. We compared several cystatin C-based equations with the modification diet renal disease (MDRD) equation in 120 adult renal transplant recipients for whom the GFR was measured by the gold standard inulin clearance. Mean inulin-measured GFR was 52.6 mL/min/1.73 m (range, 13-119). The Hoek, Rule, Le Bricon, and Filler cystatin C-based formulas showed significantly better performances (accuracy 30% of 82%, 81%, 78%, and 71%), than the MDRD equation (58%, Mac Nemar test, P<0.01). Sensitivity to detect a GFR below 60 mL/min/1.73 m was significantly higher for the Hoek and the Rule equations (0.95, 95% CI 0.91-1) than for the MDRD equation (0.76, 95% CI 0.67-0.85). These data confirm that cystatin C as a GFR marker offers significant advantages over creatinine in renal transplantation.