Title |
Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study
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Published in |
Clinical Biochemistry, November 2016
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DOI | 10.1016/j.clinbiochem.2016.11.024 |
Pubmed ID | |
Authors |
Elizabeth LM Barr, Louise J Maple-Brown, Federica Barzi, Jaquelyne T Hughes, George Jerums, Elif I Ekinci, Andrew G Ellis, Graham RD Jones, Paul D Lawton, Cherian Sajiv, Sandawana W Majoni, Alex DH Brown, Wendy E Hoy, Kerin O'Dea, Alan Cass, Richard J MacIsaac |
Abstract |
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC+cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m(2); 95%CI 13.3-16.4, p<0.001) and eGFRcysC+cr (10.3; 8.8-11.5, p<0.001) compared to eGFRcr (5.4; 3.0-7.2). Accuracy was lower for eGFRcysC (80.3%; 76.7-83.5, p<0.001) but not for eGFRcysC+cr (91.9; 89.3-94.0, p=0.29) compared to eGFRcr (90.0; 87.2-92.4). Precision was comparable for all equations. The performance of eGFRcysC deteriorated across increasing levels of c-reactive protein. Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians. |
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Geographical breakdown
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Demographic breakdown
Readers by professional status | Count | As % |
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Student > Bachelor | 6 | 15% |
Student > Master | 5 | 13% |
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Professor | 2 | 5% |
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Unknown | 12 | 30% |
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Other | 5 | 13% |
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