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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 ; Nilsson, J-A; Norrgren, Kristina LU ; Sterner, Gunnar LU and Sundkvist, Göran LU (2004) In Journal of Internal Medicine1989-01-01+01:00 256(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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author
organization
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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 Medicine1989-01-01+01:00
volume
256
issue
6
pages
510 - 518
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • wos:000225572300006
  • pmid:15554952
  • scopus:9644259120
ISSN
1365-2796
DOI
10.1111/j.1365-2796.2004.01414.xhttps://doi.org/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
2007-07-05 07:43:39
date last changed
2019-05-16 16:21:32
@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},
  keyword      = {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 Publishing Ltd},
  series       = {Journal of Internal Medicine1989-01-01+01:00},
  title        = {Serum cystatin C advantageous compared with serum creatinine in the detection of mild but not severe diabetic nephropathy.},
  url          = {http://dx.doi.org/10.1111/j.1365-2796.2004.01414.xhttps://doi.org/10.1111/j.1365-2796.2004.01414.x},
  volume       = {256},
  year         = {2004},
}