Comparison of Cystatin C and Creatinine-based Glomerular Filtration Rate Formulas with 51Cr-EDTA Clearance in Patients with Cirrhosis

Elias Xirouchakis1, Laura Marelli1, Εvangelos Cholongitas1, Pinelopi Manousou1, Vincenza Calvaruso1, M. Pleguezuelo1, Gian Piero Guerrini1, S. Maimone1, Andrew Kerry2, Mark Hajjawi2, Devaki Nair2, Michael Thomas2, David Patch1, Andrew K. Burroughs3,4,5,1
1Royal Free Sheila Sherlock Liver Centre and the University Department of Surgery and
2Department of Clinical Biochemistry, Royal Free Hospital and University College London, London, United Kingdom
3Dr. Andrew K. Burroughs, The Royal Free Sheila Sherlock Liver Centre, and Department of Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK. Phone: 44-20-74726229
4e-mail: [email protected]
5Fax: 44-20-74726226

Tóm tắt

Summary Background and objectives

Renal function is an important predictor of survival in cirrhosis and liver transplantation. GFR estimates using serum cystatin C (CysC) are proposed as better predictors of renal function than ones on the basis of serum creatinine (Cr). Our aims were: (1) evaluate correlations between serum CysC and different methods of creatinine measurements; (2) compare CysC and Cr GFR formulas with 51Cr-EDTA; and (3) evaluate liver-related parameters potentially influencing GFR.

Design, setting, participants, & measurements

254 blood samples in 65 patients with cirrhosis correlating CysC with four Cr methods were used; another 74 patients comparing 51Cr-EDTA GFR to Modification of Diet in Renal Disease and Larsson and Hoek formulas for CysC were also included. Agreement was assessed using Bland-Altman plots and concordance correlation coefficients. Multivariate linear regression analysis was used for GFR predictors.

Results

Serum CysC correlated modestly with O'Leary modified Jaffe, compensated kinetic Jaffe, enzymatic creatinine, and standard kinetic Jaffe 0.72/0.71/0.72/0.72 (all P < 0.001). Bland-Altman agreement with 51Cr-EDTA GFR was poor; the best agreement was Modification of Diet in Renal Disease (concordance 0.61; 95% CI, 0.47 to 0.71); the worst agreement was the Hoek formula (concordance 0.46; 95% CI, 0.27 to 0.61). A new GFR formula including the Child-Pugh score improved the accuracy of Cr GFR formulas compared with 51Cr-EDTA GFR.

Conclusions

Estimated GFR in cirrhosis is not better with CysC formulas compared with creatinine ones: specific formulas may be necessary.

Từ khóa


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