Discrepancies between creatinine-based and cystatin C-based equations in estimating prevalence of stage 3 chronic kidney disease in an elderly population

Background . The prevalence of stage 3 chronic kidney disease (CKD) is increasing, calculated using the modification of diet in renal disease (MDRD) study equation for estimating glomerular filtration rate (GFR). Cystatin C-based equations are also being used to estimate GFR. Using creatinine-based and cystatin C-based equations, the aim of our study was to measure the difference in prevalence of stage 3 CKD in a population. Methods . CKD screening is organized in the Province of Liege, Belgium. On a voluntary basis, people aged between 45 and 75 years are invited for screening. GFR is estimated using the MDRD study equation and by the three recent cystatin C-based equations proposed by Levey's group. The Levey 1 equation is based on cystatin C only and the Levey 2 equation on cystatin C corrected for age and sex. The Levey 3 equation combines cystatin C, creatinine, age and sex. Results . The population screened comprised 754 people. Cystatin C is highly correlated with creatinine (r=0.6196, p0.0001). Prevalence of stage 3 CKD when GFR is estimated by the MDRD equation study is 17.2 %, which is significantly and much higher than the prevalence obtained when cystatin C-based equations are used. Indeed, prevalence is 2 %, 3.3 % and 5.8 % with the Levey 1, 2 and 3 equations, respectively. Conclusions . The prevalence of stage 3 CKD varies strongly following the method used for estimating GFR, creatinine-based or cystatin C-based equations. Such discrepancies must be confirmed and explained in additional studies using GFR measured with a reference method.