Document Detail

A comparison of plasma cystatin C and plasma creatinine for the screening of renal function in lithium-treated patients.
MedLine Citation:
PMID:  20630133     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Renal insufficiency is a serious complication of lithium treatment. Therefore, regular monitoring of plasma (P) creatinine is always part of lithium treatment safety routines. Recently P-cystatin C-estimated glomerular filtration rate (cystatin C-eGFR) had been launched as a preferable alternative to P-creatinine.
AIMS: To find out which of the two alternatives to prefer in the safety routines for lithium-treated patients.
MATERIAL: All 201 patients on lithium treatment at the Department of Psychiatry in Lund, Sweden.
METHODS: During 14 months P-cystatin C was included in the safety routines besides routine P-creatinine every 4 months. At the end of the study period, 182 patients were eligible for analysis. With iohexol clearance as reference for GFR (performed in 111/182 patients) we calculated positive and negative predictive values (PPV, NPV) for P-creatinine and for creatinine-eGFR and cystatin C-eGFR, obtained by prediction equations. We also calculated the agreement between the measures of GFR (including repeatability).
RESULTS: PPV for cystatin C-eGFR (65%) was better than for creatinine-eGFR (48%). Combining the two resulted in a PPV of 56% and marginally increased NPV to 95%. The average of cystatin C-eGFR and creatinine-eGFR yielded PPV 67% and NPV 92%. The agreement between creatinine-eGFR and GFR was better than the agreement between cystatin C-eGFR and GFR, but both were clinically unacceptable. The repeatability of P-creatinine was acceptable for psychiatric purposes. The repeatability of cystatin C-eGFR was inferior to that of P-creatinine.
CONCLUSION: Our results do not justify replacing P-creatinine by cystatin C-eGFR in the lithium treatment safety routines.
C L Olsson; B Rippe; H Bendz
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical nephrology     Volume:  74     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-15     Completed Date:  2010-09-29     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  132-40     Citation Subset:  IM    
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MeSH Terms
Biological Markers / blood
Contrast Media / diagnostic use,  pharmacokinetics
Creatinine / blood*
Cystatin C / blood*
Glomerular Filtration Rate
Iohexol / diagnostic use,  pharmacokinetics
Kidney Function Tests / methods*
Lithium / administration & dosage*,  adverse effects*
Middle Aged
Predictive Value of Tests
Regression Analysis
Reproducibility of Results
Reg. No./Substance:
0/Biological Markers; 0/Contrast Media; 0/Cystatin C; 4419T9MX03/Iohexol; 9FN79X2M3F/Lithium; AYI8EX34EU/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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