Document Detail


Estimation of residual glomerular filtration rate in dialysis patients from the plasma cystatin C level.
MedLine Citation:
PMID:  17403704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Residual renal function influences morbidity, mortality and quality of life of chronic dialysis patients. Residual glomerular filtration rate (rGFR) is therefore an important parameter in the follow-up of these patients. Because rGFR is measured as the mean of creatinine and urea clearance, a complete 24 h urine collection is essential, but often very difficult to manage for these patients. METHODS: We investigated if plasma cystatin C (cysC) could give a good estimate of rGFR in dialysis patients and compared it to the measured rGFR, as well as to the rGFR estimate obtained with the Modification of Diet in Renal Disease (MDRD) formula. A total of 465 patients were included in this study. CysC levels of 215 haemodialysis (HD) and 95 chronic ambulatory peritoneal dialysis (PD) patients were used to derive a formula for rGFR. This formula was tested in the validation group of 107 HD and 48 PD patients. RESULTS: The cysC formula derived in the modelling group was rGFR = -0.70 + 22 x (1/cysC). The mean estimated rGFR obtained with this formula in the validation group was not significantly different from the mean measured rGFR: difference 0.19 ml/min/1.73 m(2), 95% confidence interval (CI) -2.37 to 2.75 ml/min/1.73 m(2). The MDRD formula gave a larger difference from the mean measured rGFR (3.13 ml/min/1.73 m(2)) and a much wider 95% CI (-1.29 to 7.55 ml/min/1.73 m(2)). A separate model for HD and PD patients did not improve the estimation of rGFR. CONCLUSIONS: The cysC formula showed better accuracy and precision than the MDRD formula. Therefore the cysC formula and not the MDRD formula should be used to calculate rGFR in dialysis patients when no 24 h urine sample is available.
Authors:
Frans J Hoek; Johanna C Korevaar; Friedo W Dekker; Elisabeth W Boeschoten; Raymond T Krediet
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Validation Studies     Date:  2007-04-01
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  22     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-28     Completed Date:  2007-08-17     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  1633-8     Citation Subset:  IM    
Affiliation:
Academic Medical Center, Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands. f.j.hoek@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
Cohort Studies
Cystatin C
Cystatins / blood*
Female
Glomerular Filtration Rate / physiology*
Humans
Kidney Diseases / blood*,  physiopathology*
Male
Middle Aged
Chemical
Reg. No./Substance:
0/Biological Markers; 0/CST3 protein, human; 0/Cystatin C; 0/Cystatins
Comments/Corrections
Comment In:
Nephrol Dial Transplant. 2008 Mar;23(3):1072-3; author reply 1073   [PMID:  17984103 ]
Nat Clin Pract Nephrol. 2007 Dec;3(12):650-1   [PMID:  17895870 ]

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