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Discordant Results Between Creatinine- and Cystatin C-based Equations for Estimating GFR

Delanaye, Pierre ; Flamant, Martin ; Vidal-Petiot, Emmanuelle ; Björk, Jonas LU orcid ; Nyman, Ulf LU ; Grubb, Anders LU orcid ; Bakker, Stephan J.L. ; de Borst, Martin H. ; van Londen, Marco and Derain-Dubourg, Laurence , et al. (2025) In Kidney International Reports 10(4). p.1248-1259
Abstract

Introduction: Discordant results between cystatin C and creatinine in estimating glomerular filtration rate (GFR) are an important medical issue. However, the equation that should be used when GFR estimates are discordant remains unclear. Methods: This cross-sectional analysis included 15,485 participants with GFR measured by the clearance of an exogenous marker, serum creatinine, and cystatin C. We studied the proportion of discordant results defined as an absolute (> 15 ml/min per 1.73 m2) or relative (> 20%) difference between creatinine-based estimated GFR (eGFR, eGFRcrea) and cystatin C–based eGFR (eGFRcys) using different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI],... (More)

Introduction: Discordant results between cystatin C and creatinine in estimating glomerular filtration rate (GFR) are an important medical issue. However, the equation that should be used when GFR estimates are discordant remains unclear. Methods: This cross-sectional analysis included 15,485 participants with GFR measured by the clearance of an exogenous marker, serum creatinine, and cystatin C. We studied the proportion of discordant results defined as an absolute (> 15 ml/min per 1.73 m2) or relative (> 20%) difference between creatinine-based estimated GFR (eGFR, eGFRcrea) and cystatin C–based eGFR (eGFRcys) using different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], European Kidney Function Consortium [EKFC], and reexpressed Lund-Malmö [r-LMR]). We also researched for the best estimating equations to be used in subjects with concordant or discordant results to estimate measured GFR (mGFR). Results: In the total cohort, the proportion of subjects with discordant results (absolute or relative) was larger for CKD-EPI (35.1 and 40.6%) than for EKFC (21.9 and 31.7%) or r-LMR (22.8 and 32.8%) equations. Among discrepant results, the proportion of eGFRcys < eGFRcrea was significantly higher than the proportion of eGFRcrea < eGFRcys for the CKD-EPI equations, whereas the occurrence of discrepancy was similar in the 2 discrepant groups for EKFC or r-LMR. For the EKFC and r-LMR equations, but not for the CKD-EPI, the equation combining creatinine and cystatin C was consistently the closest to the mGFR in the discrepant groups. Conclusion: Based on the lower discrepancy proportion, better balance between eGFRcrea and eGFRcys, and better concordance with mGFR, the EKFC, and r-LMR equations should be preferred over the CKD-EPI to estimate GFR.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
creatinine, cystatin C, glomerular filtration rate
in
Kidney International Reports
volume
10
issue
4
pages
1248 - 1259
publisher
Elsevier
external identifiers
  • pmid:40303200
  • scopus:105001081415
ISSN
2468-0249
DOI
10.1016/j.ekir.2025.01.030
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 International Society of Nephrology
id
d00a609d-9583-4c67-808f-39fa285a793c
date added to LUP
2025-05-09 09:00:48
date last changed
2025-05-23 11:27:30
@article{d00a609d-9583-4c67-808f-39fa285a793c,
  abstract     = {{<p>Introduction: Discordant results between cystatin C and creatinine in estimating glomerular filtration rate (GFR) are an important medical issue. However, the equation that should be used when GFR estimates are discordant remains unclear. Methods: This cross-sectional analysis included 15,485 participants with GFR measured by the clearance of an exogenous marker, serum creatinine, and cystatin C. We studied the proportion of discordant results defined as an absolute (&gt; 15 ml/min per 1.73 m<sup>2</sup>) or relative (&gt; 20%) difference between creatinine-based estimated GFR (eGFR, eGFR<sub>crea</sub>) and cystatin C–based eGFR (eGFR<sub>cys</sub>) using different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], European Kidney Function Consortium [EKFC], and reexpressed Lund-Malmö [r-LMR]). We also researched for the best estimating equations to be used in subjects with concordant or discordant results to estimate measured GFR (mGFR). Results: In the total cohort, the proportion of subjects with discordant results (absolute or relative) was larger for CKD-EPI (35.1 and 40.6%) than for EKFC (21.9 and 31.7%) or r-LMR (22.8 and 32.8%) equations. Among discrepant results, the proportion of eGFR<sub>cys</sub> &lt; eGFR<sub>crea</sub> was significantly higher than the proportion of eGFR<sub>crea</sub> &lt; eGFR<sub>cys</sub> for the CKD-EPI equations, whereas the occurrence of discrepancy was similar in the 2 discrepant groups for EKFC or r-LMR. For the EKFC and r-LMR equations, but not for the CKD-EPI, the equation combining creatinine and cystatin C was consistently the closest to the mGFR in the discrepant groups. Conclusion: Based on the lower discrepancy proportion, better balance between eGFR<sub>crea</sub> and eGFR<sub>cys</sub>, and better concordance with mGFR, the EKFC, and r-LMR equations should be preferred over the CKD-EPI to estimate GFR.</p>}},
  author       = {{Delanaye, Pierre and Flamant, Martin and Vidal-Petiot, Emmanuelle and Björk, Jonas and Nyman, Ulf and Grubb, Anders and Bakker, Stephan J.L. and de Borst, Martin H. and van Londen, Marco and Derain-Dubourg, Laurence and Rule, Andrew D. and Eriksen, Björn O. and Melsom, Toralf and Sundin, Per Ola and Ebert, Natalie and Schaeffner, Elke and Hansson, Magnus and Littmann, Karin and Larsson, Anders and Stehlé, Thomas and Cavalier, Etienne and Bukabau, Justine B. and Sumaili, Ernest K. and Yayo, Eric and Mariat, Christophe and Moranne, Olivier and Christensson, Anders and Lanot, Antoine and Pottel, Hans}},
  issn         = {{2468-0249}},
  keywords     = {{creatinine; cystatin C; glomerular filtration rate}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{1248--1259}},
  publisher    = {{Elsevier}},
  series       = {{Kidney International Reports}},
  title        = {{Discordant Results Between Creatinine- and Cystatin C-based Equations for Estimating GFR}},
  url          = {{http://dx.doi.org/10.1016/j.ekir.2025.01.030}},
  doi          = {{10.1016/j.ekir.2025.01.030}},
  volume       = {{10}},
  year         = {{2025}},
}