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Cystatin C May Be Superior to Creatinine in Determining CKD Risk

Cystatin C alone, or in combination with creatinine may be a better predictor for renal disease compared to creatinine alone…. 

A recent study published in the New England Journal of Medicine found that use of cystatin C alone, or in combination with creatinine may be better than creatinine alone in the determination of chronic kidney disease. A meta-analysis consisting of over 90,000 participants with CKD sought out to calculate the rates of death from all causes including heart and kidney disease using eGFR based off of creatinine or cystatin C equations.

Risk for death increased across all categories when eGFR values were determined from cystatin C. The eGFR values were lower in 14% of patients when using cystatin C values in comparison to creatinine, increasing their relative risk for death by 57% compared to reference points. For example, when basing eGFR off creatinine alone, 44% of patients had an eGFR of 60 – 89 mL/minute per 1.73 m2, but when adjusting these values using cystatin C, patients’ eGFR declined to less than 60 mL/minute. Researchers noted that this may be a result of creatinine’s sensitivity to muscle mass, diet, and physical activity.

Practice Pearls:
  • Risk for death increased when using cystatin C to estimate eGFR.
  • eGFR predictions are lower when based off cystatin C in comparison to creatinine.
  • eGFR values based off creatinine may be higher due to its susceptibility to muscle mass and physical activity.

New England Journal of Medicine, September 2013