NDT Advance Access originally published online on June 7, 2007
Nephrology Dialysis Transplantation 2007 22(10):3013-3020; doi:10.1093/ndt/gfm318
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Chronic kidney disease stage in renal transplantation—classification using cystatin C and creatinine-based equations
1Division of Nephrology, Queen's University, Kingston, 2Division of Nephrology, University of Ottawa, Ottawa, Ontario, 3Kidney Research Centre, The Ottawa Health Research Institute, Ottawa,4Division of Nuclear Medicine, Department of Medicine, 5Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, 6Department of Laboratory Medicine, Children's Hospital of Eastern Ontario and the University of Ottawa and 7Clinical Epidemiology Program, The Ottawa Health Research Institute, Canada
Correspondence and offprint requests to: Dr G. Knoll, Division of Nephrology, The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario, Canada K1H 7W9. Email: gknoll{at}ottawahospital.on.ca
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Abstract |
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Background. Current clinical guidelines recommend that renal transplant recipients (RTRs) be classified into chronic kidney disease (CKD) stage using a creatinine-based estimate of glomerular filtration rate (GFR). However, creatinine-based equations are inaccurate in RTRs leading to frequent CKD stage misclassification. It is not known whether the classification of CKD stage would be improved using a cystatin C-based estimate of GFR.
Methods. We measured 99mTc-DTPA GFR, cystatin C and creatinine in 198 stable RTRs. GFR was estimated using cystatin C-based equations (Filler, Le Bricon and Rule) and four creatinine-based equations. We determined the proportion, overall and by CKD stage, that were classified correctly by each equation as compared to the 99mTc-DTPA GFR.
Results. The Filler equation correctly classified 76% of patients compared to only 65% with the abbreviated modification of diet in renal disease (MDRD) equation and 69% with the Cockcroft–Gault equation. In CKD stages two and four, the Filler equation correctly classified 77% and 60% of patients whereas the abbreviated MDRD equation correctly classified 46% and 93% of patients. The area under the curve by receiver operating curve analysis for overall stage classification was uniformly poor for all equations (0.52–0.56).
Conclusions. The cystatin C-based Filler and Le Bricon GFR estimates classified slightly more patients into the correct CKD stage than the standard creatinine-based equations in stable RTRs although the overall diagnostic accuracies were similar. The differences are modest and prospective studies will be needed to determine if the adoption of these equations for classification would lead to improved recognition of CKD complications or patient care.
Keywords: chronic kidney disease; creatinine; cystatin c; glomerular filtration rate; kidney transplantation
Received for publication: 10.10.06
Accepted in revised form: 27. 4.07
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