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Serum cystatin C advantageous compared with serum creatinine in the detection of mild but not severe diabetic nephropathy.

Christensson, Anders LU ; Grubb, Anders LU orcid ; Nilsson, J-A ; Norrgren, Kristina LU ; Sterner, Gunnar LU and Sundkvist, Göran LU (2004) In Journal of Internal Medicine 256(6). p.510-518
Abstract

OBJECTIVE: To determine whether serum cystatin C is more accurate than serum creatinine in the detection of diabetic nephropathy, also after adjustment for age.

METHODS: Forty-one patients with type 1 and 82 patients with type 2 diabetes were evaluated with serum creatinine, serum cystatin C, and (51)Cr-EDTA clearance (reference method). Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. Statistical estimations were performed both without and with age adjustment created by z-scores for (51)Cr-EDTA clearance, creatinine, and cystatin C. The cut-off levels for glomerular filtration rate (GFR) ((51)Cr-EDTA clearance) were 60 and 80 mL min(-1) 1.73 m(-2), respectively, in... (More)

OBJECTIVE: To determine whether serum cystatin C is more accurate than serum creatinine in the detection of diabetic nephropathy, also after adjustment for age.

METHODS: Forty-one patients with type 1 and 82 patients with type 2 diabetes were evaluated with serum creatinine, serum cystatin C, and (51)Cr-EDTA clearance (reference method). Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. Statistical estimations were performed both without and with age adjustment created by z-scores for (51)Cr-EDTA clearance, creatinine, and cystatin C. The cut-off levels for glomerular filtration rate (GFR) ((51)Cr-EDTA clearance) were 60 and 80 mL min(-1) 1.73 m(-2), respectively, in absolute values and 80, 90 and 95% CIs, respectively, in age-adjusted values (z-scores).

RESULTS: Estimations without age adjustment showed significantly (P = 0.0132) closer correlation for cystatin C (r = 0.817) versus (51)Cr-EDTA clearance as compared with creatinine (r = 0.678). However, when using age-adjusted values, the correlation for cystatin C and creatinine, respectively, versus (51)Cr-EDTA clearance did not differ. When comparing the diagnostic utilities for serum cystatin C versus serum creatinine in manifest renal impairment (GFR < 60 mL min(-1) 1.73 m(-2) or z-scores <-1.28 SD), there were no significant differences between the two markers whether age adjusted or not. However, for diagnosing mild nephropathy (GFR < 80 mL min(-1) 1.73 m(-2) or z-score -0.84 SD), serum cystatin C is significantly more useful.

CONCLUSIONS: Serum cystatin C performed better compared with serum creatinine even when measured enzymatically, to detect mild diabetic nephropathy. However, serum creatinine was as efficient as serum cystatin C to detect advanced diabetic nephropathy.

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; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Age Factors, Aged, Albuminuria/etiology, Biomarkers/blood, Creatinine/blood, Cystatin C, Cystatins/blood, Diabetes Mellitus, Type 1/blood, Diabetes Mellitus, Type 2/blood, Diabetic Nephropathies/blood, Female, Glomerular Filtration Rate, Humans, Kidney Function Tests/methods, Male, Middle Aged, Prospective Studies, ROC Curve
in
Journal of Internal Medicine
volume
256
issue
6
pages
510 - 518
publisher
Wiley-Blackwell
external identifiers
  • wos:000225572300006
  • pmid:15554952
  • scopus:9644259120
  • pmid:15554952
ISSN
1365-2796
DOI
10.1111/j.1365-2796.2004.01414.x
language
English
LU publication?
yes
id
405090f3-1d2b-4270-b7c6-1041fa293040 (old id 130735)
date added to LUP
2016-04-01 15:39:44
date last changed
2023-01-04 18:31:03
@article{405090f3-1d2b-4270-b7c6-1041fa293040,
  abstract     = {{<p>OBJECTIVE: To determine whether serum cystatin C is more accurate than serum creatinine in the detection of diabetic nephropathy, also after adjustment for age.</p><p>METHODS: Forty-one patients with type 1 and 82 patients with type 2 diabetes were evaluated with serum creatinine, serum cystatin C, and (51)Cr-EDTA clearance (reference method). Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. Statistical estimations were performed both without and with age adjustment created by z-scores for (51)Cr-EDTA clearance, creatinine, and cystatin C. The cut-off levels for glomerular filtration rate (GFR) ((51)Cr-EDTA clearance) were 60 and 80 mL min(-1) 1.73 m(-2), respectively, in absolute values and 80, 90 and 95% CIs, respectively, in age-adjusted values (z-scores).</p><p>RESULTS: Estimations without age adjustment showed significantly (P = 0.0132) closer correlation for cystatin C (r = 0.817) versus (51)Cr-EDTA clearance as compared with creatinine (r = 0.678). However, when using age-adjusted values, the correlation for cystatin C and creatinine, respectively, versus (51)Cr-EDTA clearance did not differ. When comparing the diagnostic utilities for serum cystatin C versus serum creatinine in manifest renal impairment (GFR &lt; 60 mL min(-1) 1.73 m(-2) or z-scores &lt;-1.28 SD), there were no significant differences between the two markers whether age adjusted or not. However, for diagnosing mild nephropathy (GFR &lt; 80 mL min(-1) 1.73 m(-2) or z-score -0.84 SD), serum cystatin C is significantly more useful.</p><p>CONCLUSIONS: Serum cystatin C performed better compared with serum creatinine even when measured enzymatically, to detect mild diabetic nephropathy. However, serum creatinine was as efficient as serum cystatin C to detect advanced diabetic nephropathy.</p>}},
  author       = {{Christensson, Anders and Grubb, Anders and Nilsson, J-A and Norrgren, Kristina and Sterner, Gunnar and Sundkvist, Göran}},
  issn         = {{1365-2796}},
  keywords     = {{Adult; Age Factors; Aged; Albuminuria/etiology; Biomarkers/blood; Creatinine/blood; Cystatin C; Cystatins/blood; Diabetes Mellitus, Type 1/blood; Diabetes Mellitus, Type 2/blood; Diabetic Nephropathies/blood; Female; Glomerular Filtration Rate; Humans; Kidney Function Tests/methods; Male; Middle Aged; Prospective Studies; ROC Curve}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{510--518}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Internal Medicine}},
  title        = {{Serum cystatin C advantageous compared with serum creatinine in the detection of mild but not severe diabetic nephropathy.}},
  url          = {{https://lup.lub.lu.se/search/files/4443690/624167.pdf}},
  doi          = {{10.1111/j.1365-2796.2004.01414.x}},
  volume       = {{256}},
  year         = {{2004}},
}