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A comparison of plasma cystatin C and plasma creatinine for the screening of renal function in lithium-treated patients.

Olsson, C L; Rippe, Bengt LU and Bendz, Hans LU (2010) In Clinical Nephrology 74(2). p.132-140
Abstract
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Nephrology
volume
74
issue
2
pages
132 - 140
publisher
Dustri-Verlag
external identifiers
  • WOS:000280754500007
  • PMID:20630133
  • Scopus:77955723246
ISSN
0301-0430
language
English
LU publication?
yes
id
43d50b1a-4a97-48ae-af6a-12d75974e182 (old id 1644966)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20630133?dopt=Abstract
date added to LUP
2010-08-03 09:32:03
date last changed
2016-10-13 04:31:13
@misc{43d50b1a-4a97-48ae-af6a-12d75974e182,
  abstract     = {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.},
  author       = {Olsson, C L and Rippe, Bengt and Bendz, Hans},
  issn         = {0301-0430},
  language     = {eng},
  number       = {2},
  pages        = {132--140},
  publisher    = {ARRAY(0x7647e70)},
  series       = {Clinical Nephrology},
  title        = {A comparison of plasma cystatin C and plasma creatinine for the screening of renal function in lithium-treated patients.},
  volume       = {74},
  year         = {2010},
}