Cystatin C Levels in Functionally Anephric Patients Undergoing Dialysis: The Effect of Different Methods and Intensities

Background and objectives: Cystatin C, a low molecular weight protein, is produced by nucleated cells, filtered by glomeruli, and degraded by tubules at a constant rate. Its serum concentration has been proposed as a marker of GFR. Its size should make it dialyzable. It is hypothesized that serum cystatin C levels are influenced by the method and intensity of dialysis received. Design: This is a cross-sectional pilot study of cystatin C in functionally anephric dialysis patients. It was measured predialysis in 14 patients on conventional (3 to 5 h, 3 x wk) hemodialysis; eight on nocturnal hemodialysis (three to seven nights, 6 to 8 h); three on daily hemodialysis (6 d, 1 1/2 to 2 1/2 h); and 10 on automated peritoneal dialysis. All had urea kinetic studies and values for single pool Kt/V (Sp Kt/V), standard weekly Kt/V (Std Kt/V), and protein equivalent of nitrogen appearance (nPNA; g/kg/d). C reactive protein (CRP; mg/L) and thyroid stimulating hormone (TSH; mIU/L) were measured as factors known to influence cystatin C. Results: There was no correlation between cystatin C and Sp Kt/V, but there was a significant inverse linear correlation with Std Kt1V and there were significant differences between treatment modalities in cystatin C levels and in Std Kt/V. The estimation of cystatin C was reliable and stable over 3 to 6 wk and its levels uninfluenced by nPNA, CRP, or TSH. Conclusion: Serum cystatin C levels are influenced by the method and intensity of dialysis and may have a role in treatment adequacy monitoring. Clin J Am Soc Nephrol 4: 1606-1610, 2009. doi: 10.2215/CJN.02910509