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KMID : 0948320060060020066
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Konyang Medical Journal
2006 Volume.6 No. 2 p.66 ~ p.71
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Adequate Predictor for Estimating Renal Function in Renal Transplant Patients
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Choi Nak-Won
Kang Chong-Myung
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Abstract
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Background: As compared with serum creatinine, serum cystatin C has been proposed to be an alternative or a more sensitive glomerular filtration rate (GFR) marker because it appears to be independent of age, sex, muscle mass, and protein intake. This study was undertaken to evaluate correlation between serum cystatin C and GFR estimates and to compare the diagnostic accuracy of serum cystatin C with that of serum creatinine in detection of a moderate reduction of GFR.
Methods: Serum cystatin C, serum creatinine and 24-hour creatinine clearance were measured in 40 adult renal transplant recipients. Three different GFR estimates were used: 24-hour creatinine clearance corrected for 1.73 m2 of body surface area, Modification of Diet in Renal Disease (MDRD) equation, and Cockcroft-Gault formula. Linear regression analysis was performed to evaluate correlations between GFR estimates and serum cystatin C, and nonparametric receiver operating characteristic (ROC) analysis was carried out to compare the diagnostic accuracy of serum cystatin C with that of serum creatinine using a cut-off GFR at 60 mL/min/1.73 m2.
Results: Significant correlations were noted between each of the 3 different GFR estimates and serum cystatin C. Serum cystatin C also correlated significantly with serum creatinine. In the ROC analysis using 24-hour creatinine clearance for the GFR standard, the area under the curve (AUC) for cystatin C and creatinine were 0.86±0.06 and 0.81±0.07, respectively (P=0.30). When GFR was estimated from MDRD equation, the AUC for cystatin C and creatinine were 0.84±0.07 and 0.94±0.04, respectively (P=0.10). When GFR was estimated from Cockcroft-Gault formula, the AUC for cystatin C and creatinine were 0.86±0.06 and 0.87±0.06, respectively (P=0.95).
Conclusion: Serum cystatin C is a useful marker for the assessment of GFR in renal transplant recipients, but it is not clear whether cystatin C is superior to creatinine in detection of a mild to moderate renal impairment. Application of “gold standard” reference method for GFR measurement to the patients with variable ranges of GFR should be required in future studies.
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KEYWORD
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Kidney Transplantation, Glomerular filtration Rate, Cystatin C, Creatinine
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