NDT Advance Access originally published online on December 2, 2005
Nephrology Dialysis Transplantation 2006 21(3):660-664; doi:10.1093/ndt/gfi305
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients
1 Department of Internal Medicine I, University of Bonn, Germany and 2 Department of Clinical Biochemistry, University of Bonn, Germany
Correspondence and offprint requests to: Dr Uwe Pöge, Department of Internal Medicine I, University of Bonn, Sigmund-Freud- Straße 25, D 53105 Bonn, Germany. Email: u.poege{at}uni-bonn.de
Background. Plasma creatinine and creatinine clearance are of limited value for the estimation of renal function in cirrhotics. In these patients, cystatin C (Cys C) has been proposed as an alternative marker of glomerular filtration rate (GFR) and Cys C-based equations for calculation of GFR have been developed in non-cirrhotic patient cohorts.
Methods. We retrospectively analyzed correlation, bias, precision and accuracy of two Cys C-based formulae (Larsson and Hoek) for GFR estimation in comparison with two creatinine-based equations (Cockroft & Gault and MDRD). The Cys C was determined by an immunonephelometric method. The GFR was measured by means of inulin clearance in 44 consecutive patients with liver cirrhosis.
Results. On average, inulin clearance was 28.3 (95% CI: 29.2–41.3 ml/min/1.73 m2). Creatinine as well as Cys C-based equations overestimated the true GFR by 105–154%. However, Cys C-based equations showed significantly lower bias and higher precision than the creatinine-based formulae. Correlation and accuracy tended to be better with the Hoek and Larsson equation than with the Cockroft & Gault or MDRD formulae. Hoek and Larsson equations showed a similar diagnostic performance in all statistical procedures.
Conclusion. Our data suggest a significant improvement of GFR estimation in liver cirrhotics by means of the Cys C-based Hoek and Larsson formulae. However, all estimates remain a crude approximation of true GFR and thus cannot replace gold standard methods.
Keywords: accuracy; cystatin C; equations; glomerular filtration rate; inulin clearance; liver cirrhosis
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