Estimating glomerular filtration rate in kidney transplantation: A comparison between serum creatinine and cystatin C-based methods

被引:148
作者
White, C
Akbari, A
Hussain, N
Dinh, L
Filler, G
Lepage, N
Knoll, GA
机构
[1] Univ Ottawa, Dept Med, Div Nephrol, Ottawa, ON K1N 6N5, Canada
[2] Univ Ottawa, Dept Med, Div Nucl Med, Ottawa, ON K1N 6N5, Canada
[3] Ottawa Hlth Res Inst, Kidney Res Ctr, Ottawa, ON K1N 6N5, Canada
[4] Ottawa Hlth Res Inst, Clin Epidemiol Program, Ottawa, ON K1N 6N5, Canada
[5] Childrens Hosp Eastern Ontario, Div Nephrol, Dept Pediat, Ottawa, ON K1H 8L1, Canada
[6] Childrens Hosp Eastern Ontario, Dept Lab Med, Ottawa, ON K1H 8L1, Canada
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2005年 / 16卷 / 12期
关键词
D O I
10.1681/ASN.2005050512
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Accurate measurement of GFR is critical for the evaluation of new therapies and the care of renal transplant recipients. Although not accurate in renal transplantation, GFR is often estimated using creatinine-based equations. Cystatin C is a marker of GFR that seems to be more accurate than creatinine. Equations to predict GFR based on the serum cystatin C concentration have been developed, but their accuracy in transplantation is unknown. GFR was estimated using four equations (Filler, Le Bricon, Larsson, and Hoek) that are based on serum cystatin C and seven equations that are based on serum creatinine in 117 adult renal transplant recipients. GFR was measured using radiolabeled diethylenetriaminepentaacetic acid (Tc-99m-DTPA), and the bias, precision, and accuracy of each equation were determined. The mean Tc-99m-DTPA GFR was 58 +/- 23 ml/min per 1.73 m(2). The cystatin C-based equations of Filler and Le Bricon had the lowest bias (-1.7 and -3.8 ml/min per 1.73 m(2)), greatest precision (11.4 and 11.8 ml/min per 1.73 m(2)), and highest accuracy (87 and 89% within 30% of measured GFR, respectively). The cystatin C equations remained accurate even when the measured GFI: was > 60 ml/min per 1.73 m2. The creatinine-based equations were not as accurate, with only 53 to 80% of estimates within 30% of measured GFR. Cystatin C-based equations are more accurate at predicting GFR in renal transplant recipients than traditional creatinine-based equations. Further prospective studies with repetitive measurement of cystatin C are needed to determine whether cystatin C-based estimates of GFR will be sufficiently accurate to monitor long-term allograft function.
引用
收藏
页码:3763 / 3770
页数:8
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