Cystatin C Predicts Renal Recovery Earlier Than Creatinine Among Patients With Acute Kidney Injury

Introduction: Serum cystatin C increases earlier than creatinine during acute kidney injury. However, whether cystatin C decreases earlier during recovery is unknown. This retrospective study aimed to determine the temporal trend between creatinine and cystatin C in acute kidney injury. Methods: We identified hospitalized patients with nonoliguric acute kidney injury who had serial creatinine and cystatin C values measured between May 2015 and May 2016. Demographic and laboratory data, causes of acute kidney injury, and relevant comorbidity data were collected through chart review. Results: For the 63 identified patients, mean (SD) age was 58.7 (13.9) years; male sex, 62%; white race/ethnicity, 95%. Baseline median (range) creatinine was 1.1 (0.5-3.0) mg/dl; 13% were kidney transplant recipients and 37% received corticosteroids. Comorbidities included malignancy (38%), diabetes mellitus (33%), heart failure (19%), and thyroid disorder (16%). The cause of kidney injury was acute tubular necrosis in 71%, 61% had acute kidney injury stage III, and 33% required dialysis. Cystatin C began to decrease before creatinine in 68% of patients: 1 day earlier, 46%; 2 days earlier, 16%; and 3 days earlier, 6%. In 24% of cases, both began decreasing on the same day; in only 8%, cystatin C decreased after creatinine. Overall, cystatin C mean (95% confidence interval) decrease was 0.92 (0.65-1.18) days before creatinine (P < 0.001). Conclusion: In summary, cystatin C decreases before creatinine in most hospitalized patients with acute kidney injury. If confirmed in large prospective studies, these findings may have important management implications, possibly shortening hospital stay and reducing costs.