Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary
Rationale & Objective: Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C for confirmation. The objective of this...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Kidney Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059523000043 |
| _version_ | 1811154751001198592 |
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| author | Eric Raphael Gottlieb Christopher Estiverne Nicole V. Tolan Stacy E.F. Melanson Mallika L. Mendu |
| author_facet | Eric Raphael Gottlieb Christopher Estiverne Nicole V. Tolan Stacy E.F. Melanson Mallika L. Mendu |
| author_sort | Eric Raphael Gottlieb |
| collection | DOAJ |
| description | Rationale & Objective: Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C for confirmation. The objective of this study was to examine the following parameters: (1) how cystatin C correlates with creatinine eGFR; (2) how it indicates differences in CKD staging; and (3) how it may affect kidney care delivery. Study Design: Retrospective observational cohort study. Setting & Participants: 1,783 inpatients and outpatients who had cystatin C and creatinine levels drawn within 24 hours at Brigham Health-affiliated clinical laboratories. Predictors: Serum creatinine levels, basic clinical/sociodemographic variables, and reasons for ordering cystatin C from a structured partial chart review. Analytical Approach: Univariate and multivariable linear and logistic regression. Results: Cystatin C-based eGFR was very strongly correlated with creatinine-based eGFR (Spearman correlation ρ = 0.83). Cystatin C eGFR resulted in a change to a later CKD stage in 27%, an earlier stage in 7%, and no change in 66% of patients. Black race was associated with a lower likelihood of change to a later stage (OR, 0.53; 95% CI [0.36, 0.75]; P < 0.001), whereas age (OR per year OR, 1.03; 95% CI [1.02, 1.04]; P < 0.001) and Elixhauser score (OR per point OR, 1.22; 95% CI [1.10, 1.36]; P < 0.001) were associated with a higher likelihood of change to a later stage. Limitations: Single center, no direct measurement of clearance for comparison, and inconsistent self-identification of race/ethnicity. Conclusions: Cystatin C eGFR correlates strongly with creatinine eGFR but can have a substantial effect on CKD staging. As cystatin C is adopted, clinicians must be informed on this impact. |
| first_indexed | 2024-04-10T04:21:14Z |
| format | Article |
| id | doaj.art-ed2ee8f46d5d40ac80f5448cbf574405 |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-04-10T04:21:14Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-ed2ee8f46d5d40ac80f5448cbf5744052023-03-11T04:20:24ZengElsevierKidney Medicine2590-05952023-03-0153100600Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language SummaryEric Raphael Gottlieb0Christopher Estiverne1Nicole V. Tolan2Stacy E.F. Melanson3Mallika L. Mendu4Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts; Address for Correspondence: Eric R. Gottlieb, MD, MS, Department of Medicine, Mount Auburn Hospital, 300 Mount Auburn St, Cambridge, MA 02138.Harvard Medical School, Boston, Massachusetts; Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MassachusettsHarvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women’s Hospital, Boston, MassachusettsHarvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women’s Hospital, Boston, MassachusettsHarvard Medical School, Boston, Massachusetts; Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MassachusettsRationale & Objective: Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C for confirmation. The objective of this study was to examine the following parameters: (1) how cystatin C correlates with creatinine eGFR; (2) how it indicates differences in CKD staging; and (3) how it may affect kidney care delivery. Study Design: Retrospective observational cohort study. Setting & Participants: 1,783 inpatients and outpatients who had cystatin C and creatinine levels drawn within 24 hours at Brigham Health-affiliated clinical laboratories. Predictors: Serum creatinine levels, basic clinical/sociodemographic variables, and reasons for ordering cystatin C from a structured partial chart review. Analytical Approach: Univariate and multivariable linear and logistic regression. Results: Cystatin C-based eGFR was very strongly correlated with creatinine-based eGFR (Spearman correlation ρ = 0.83). Cystatin C eGFR resulted in a change to a later CKD stage in 27%, an earlier stage in 7%, and no change in 66% of patients. Black race was associated with a lower likelihood of change to a later stage (OR, 0.53; 95% CI [0.36, 0.75]; P < 0.001), whereas age (OR per year OR, 1.03; 95% CI [1.02, 1.04]; P < 0.001) and Elixhauser score (OR per point OR, 1.22; 95% CI [1.10, 1.36]; P < 0.001) were associated with a higher likelihood of change to a later stage. Limitations: Single center, no direct measurement of clearance for comparison, and inconsistent self-identification of race/ethnicity. Conclusions: Cystatin C eGFR correlates strongly with creatinine eGFR but can have a substantial effect on CKD staging. As cystatin C is adopted, clinicians must be informed on this impact.http://www.sciencedirect.com/science/article/pii/S2590059523000043Chronic kidney diseasekidney functionglomerular filtration ratecreatininecystatin C |
| spellingShingle | Eric Raphael Gottlieb Christopher Estiverne Nicole V. Tolan Stacy E.F. Melanson Mallika L. Mendu Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary Kidney Medicine Chronic kidney disease kidney function glomerular filtration rate creatinine cystatin C |
| title | Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary |
| title_full | Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary |
| title_fullStr | Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary |
| title_full_unstemmed | Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary |
| title_short | Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort StudyPlain-Language Summary |
| title_sort | estimated gfr with cystatin c and creatinine in clinical practice a retrospective cohort studyplain language summary |
| topic | Chronic kidney disease kidney function glomerular filtration rate creatinine cystatin C |
| url | http://www.sciencedirect.com/science/article/pii/S2590059523000043 |
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