What can cystatin C test contribute to chronic kidney disease management?

October 10, 2017, Public Library of Science
Credit: CC0 Public Domain

The use of cystatin C along with creatinine to estimate the glomerular filtration rate (GFR) when diagnosing chronic kidney disease (CKD) in primary care patients would result in increased health care costs and no improvement in risk prediction, according to a new study published in PLOS Medicine by Adam Shardlow of the University of Nottingham, UK and colleagues.

Estimation of GFR from creatinine may be inaccurate in some people, and potentially lead to the over-diagnosis of CKD, so international and national guideline have recently recommended confirming borderline cases of CKD with an estimation of GFR based on cystatin C. In the new study, researchers estimated GFR from serum creatinine and cystatin C in a cohort of 1741 adults diagnosed with CKD in between 2008 and 2010. They compared the GFR calculated by each method both at baseline and over five years of follow-up.

The use of cystatin C to confirm a diagnosis of CKD resulted in 7.7% of people (50 of 653) being reclassified to not have CKD, but 59.0% of people (385 of 653) being reclassified to a lower eGFR, indicating more advanced CKD. In addition, change in eGFR based on cystatin C over five years identified more people as having CKD progression. However, use of cystatin C did not improve discrimination in models, and increased the cost of monitoring by £23 per patient in the first year of implementation.

"In a primary care setting, the potential benefit of reducing over-diagnosis of CKD with [cystatin C] would be eliminated by the unintended consequence of greater reclassification to more advanced CKD, requiring more frequent monitoring and increased referrals to secondary care."

Explore further: Serum cystatin C predicts mortality with cirrhotic ascites

More information: Shardlow A, McIntyre NJ, Fraser SDS, Roderick P, Raftery J, Fluck RJ, et al. (2017) The clinical utility and cost impact of cystatin C measurement in the diagnosis and management of chronic kidney disease: A primary care cohort study. PLoS Med 14(10): e1002400. doi.org/10.1371/journal.pmed.1002400

Related Stories

Serum cystatin C predicts mortality with cirrhotic ascites

September 23, 2017
(HealthDay)—Serum cystatin C level is an excellent predictor of mortality in patients with cirrhotic ascites, according to a study published online Sept. 14 in the Journal of Gastroenterology and Hepatology.

New, combined equation more accurately estimates GFR

July 6, 2012
(HealthDay) -- A combined creatinine-cystatin C equation has improved performance and accuracy for estimating glomerular filtration rate (GFR), according to research published in the July 5 issue of the New England Journal ...

Metformin eligibility up with eGFR versus serum creatinine

November 5, 2015
(HealthDay)—Use of estimated glomerular filtration rate (eGFR) rather than serum creatinine (sCr) can expand metformin eligibility, according to a study published in the November issue of Diabetes Care.

Combined use of three markers for kidney disease may help predict risk of kidney failure, death

April 11, 2011
Combining the chronic kidney disease markers of creatinine-based estimated glomerular filtration rate and urine albumin-to-creatinine ratio with the biomarker cystatin C was associated with improved prediction of end-stage ...

Relationship of kidney function estimates to risk improves by measuring cystatin C in the blood

September 4, 2013
A new, international study from the Chronic Kidney Disease Prognosis Consortium found that use of blood levels of cystatin C to estimate kidney function—alone or in combination with creatinine—strengthens the association ...

Simple blood test identifies persons at highest risk for kidney disease complications

December 16, 2010
An infrequently used blood test can effectively identify individuals at increased risk of developing complications associated with chronic kidney disease (CKD), according to a study appearing in an upcoming issue of the Journal ...

Recommended for you

Deadly Rift Valley fever: New insight, and hope for the future

July 19, 2018
Health control measures alone could be ineffective in the long term fight against the deadly Rift Valley fever which affects both humans and animals, a new study in the journal PNAS reports.

Yeast species used in food industry causes disease in humans

July 19, 2018
A major cause of drug-resistant clinical yeast infections is the same species previously regarded as non-pathogenic and commonly used in the biotechnology and food industries. The study, published on July 19th in the open-access ...

New guidelines to diagnose, manage rare endocrine disorders

July 19, 2018
International guidelines have been published for the first time to help doctors around the globe diagnose and manage patients with a very rare set of endocrine diseases known as pseudohypoparathyroidism and its related disorders, ...

Overuse of antibiotics not what the doctor ordered

July 19, 2018
With increased use of antibiotics worldwide linked to growing antibiotic resistance, a world-first study co-authored by a QUT researcher has highlighted the growing impact of non-prescription supply of antibiotics in community ...

Alcohol-related cirrhosis deaths skyrocket in young adults

July 18, 2018
Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

Childhood abuse linked to greater risk of endometriosis, study finds

July 17, 2018
Endometriosis, a painful condition that affects one in 10 reproductive-age women in the U.S., has been linked to childhood physical and sexual abuse, according to findings published today in the journal Human Reproduction.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.