Renal function in community-dwelling frail elderly. Comparison between measured and predicted glomerular filtration rate in the elderly and proposal for a new cystatin C-based prediction equation

2008 ◽  
Vol 20 (3) ◽  
pp. 216-225 ◽  
Author(s):  
Anna Törner ◽  
Ingegerd Odar-Cederlöf ◽  
Anders Kallner ◽  
Gunnar Akner
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Frail Elderly ◽  
Filtration Rate ◽  
The Elderly ◽  
Prediction Equation ◽  
Community Dwelling

scholarly journals Two-Hour Creatinine Clearance and Glomerular Filtration Rate Estimated from Serum Cystatin C and Creatinine in the Elderly to Preoperative Period

2013 ◽  
Vol 03 (04) ◽  
pp. 184-188
Author(s):  
Leopoldo Muniz da Silva ◽  
Pedro Thadeu Galvão Vianna ◽  
Mariana Takaku ◽  
Glênio Bittencourt Mizubuti ◽  
Yara Marcondes Machado Castiglia
Keyword(s):  
Glomerular Filtration Rate ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
The Elderly ◽  
Preoperative Period ◽  
Serum Cystatin C ◽  
Serum Cystatin

scholarly journals P06 Improving renal function monitoring during chemotherapy- a role for cystatin C?

2020 ◽  
Vol 105 (9) ◽  
pp. e8.2-e9
Author(s):  
Rachel Boys
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Estimating Equations ◽  
Transformation Factor ◽  
Over Time

AimRenal toxicity causes major morbidity following chemotherapy- abnormal iGFRs may be detected in up to 73.7% of patients.1 Creatinine is universally used as a biomarker to track fluctuating function and to calculate surrogate glomerular filtration rate (GFR) in the form of estimating equations.2 There is concern regarding the suitability of creatinine as a biomarker in this population, and it is proposed that cystatin C as a biomarker alone and also included in estimating equations may offer improved clinical suitability and accuracy.3MethodsIn this prospective, longitudinal study over a period of 18 months, 132 combined isotope GFR (iGFR), creatinine and cystatin C measurements were taken from 48 paediatric oncology patients at a Northern Children’s Hospital. Correlation and agreement analysis was performed for both individual biomarkers and estimating equations. Sensitivity data, along with ROC curve analysis was performed for all biomarkers and estimating equations. Data from three identified patients was isolated to examine individual patient variation over time.ResultsCreatinine identified only 1/32 patients with an abnormal iGFR (<90 ml/min/1.73 m2) compared to cystatin C which identified 12/32. Creatinine values and both estimating equations failed to change significantly over a period of declining iGFR though cystatin C did show a significant inverse increase (p<0.05). Bland Altman analysis for both the creatinine and combined equation showed poor agreement (mean difference -64 ml/min/1.3 m2 and -20 ml/min/1.73 m2 respectively). All biomarkers and equations showed poor sensitivity to detect an abnormal iGFR either below 70 ml/min/1.73 m2 or 90 ml/min/1.73 m2. A transformation factor applied to the equations significantly improved the sensitivity and clinical applicability of all equations. The data from three individual patients failed to reveal any significant intra-patient relationships.ConclusionData from this study cannot support the use of creatinine or cystatin C as a single biomarker to monitor renal function in children undergoing chemotherapy. Newer cystatin C and creatinine combined equations, whilst offering statistical superiority, do not offer the clinical superiority to replace iGFR or provide a tool for accurate dose calculations. A transformation factor can be applied to the results gained from the estimating equations to significantly improve the detection of abnormal iGFR, though work in other patient cohorts is needed to support this. Previous work also supported the use of a transformation factor, though application of their transformation factor to this current cohort failed to replicate the 100% sensitivity findings previously demonstrated4. Three patients were identified from the cohort and their paired iGFR and estimated GFR were monitored prospectively, over a period of approximately a year. Significant variation was observed between iGFR and eGFR at each time point for all three patients and therefore personalisation of GFR estimation from baseline iGFR and demographic data could not be proposed. This requires exploration in a larger cohort with the possible inclusion of additional baseline variables.ReferencesCRUK Survival trends over time in Children’s Cancers. 1.2015. https://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers/survival#heading-Two Accessed 28th March 2019.NICE ( 2013) CG169 Acute kidney injury: Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy.Barnfield, MC, Burniston, MT, Reid, U, et al. Cystatin C in assessment of glomerular filtration rate in children and young adults suffering from cancer. Nuclear Medicine Communications 2013;34:609–614.Dodgshun, AJ, Quinlan, C, Sullivan, MJ. Cystatin C based equation accurately estimates glomerular filtration rate in children with solid and central nervous system tumours: enough evidence to change practice? Pediatric Blood and Cancer 2016;63:1535–1538.

scholarly journals Simple Cystatin C–Based Prediction Equations for Glomerular Filtration Rate Compared with the Modification of Diet in Renal Disease Prediction Equation for Adults and the Schwartz and the Counahan–Barratt Prediction Equations for Children

2005 ◽  
Vol 51 (8) ◽  
pp. 1420-1431 ◽  
Author(s):  
Anders Grubb ◽  
Ulf Nyman ◽  
Jonas Björk ◽  
Veronica Lindström ◽  
Bengt Rippe ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Standard Procedure ◽  
Plasma Concentrations ◽  
Prediction Equation ◽  
Prediction Equations ◽  
Median Percentage

Abstract Background: Serum creatinine is the most commonly used marker for estimation of glomerular filtration rate (GFR). To compensate for its drawbacks as a GFR marker, several prediction equations including several parameters are being used, with the Modification of Diet in Renal Disease (MDRD), Schwartz, and Counahan–Barratt equations being the ones most widely accepted for estimation of relative GFR in mL · min−1 · (1.73 m2)−1. The present study analyzes whether these GFR prediction equations for adults and children might be replaced by simple prediction equations based on plasma concentrations of cystatin C. Methods: Data from 536 patients (0.3–93 years), consecutively referred for determination of GFR by an invasive gold standard procedure, were used for the analysis. Calculations of bias (median percentage of error), correlation (adjusted R2), and percentage of estimates within 30% and 50% of measured GFR were used in the comparisons. Results: A cystatin C–based prediction equation using only concentration in mg/L and a prepubertal factor: GFR [mL · min−1 · (1.73 m2)−1] = 84.69 × cystatin C (mg/L)−1.680 × 1.384 (if a child &lt;14 years) assessed GFR equally well or better than the simplified MDRD, the Schwartz, and the Counahan–Barratt prediction equations for the adult (≥18 years) and juvenile groups of the investigated cohort. Age did not influence the cystatin C–based prediction equation for adults, whereas gender did, but with a factor close to unity (0.948 for females). Conclusion: A GFR prediction equation based solely on cystatin C (in mg/L) and a prepubertal factor might replace the simplified MDRD prediction equation for adults and the Schwartz and Counahan–Barratt prediction equations for children.

scholarly journals The Error of Estimated GFR in Type 2 Diabetes Mellitus

2019 ◽  
Vol 8 (10) ◽  
pp. 1543 ◽  
Author(s):  
Sergio Luis-Lima ◽  
Tomás Higueras Linares ◽  
Laura Henríquez-Gómez ◽  
Raquel Alonso-Pescoso ◽  
Angeles Jimenez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate

Type 2 diabetes mellitus represents 30–50% of the cases of end stage renal disease worldwide. Thus, a correct evaluation of renal function in patients with diabetes is crucial to prevent or ameliorate diabetes-associated kidney disease. The reliability of formulas to estimate renal function is still unclear, in particular, those new equations based on cystatin-C or the combination of creatinine and cystatin-C. We aimed to assess the error of the available formulas to estimate glomerular filtration rate in diabetic patients. We evaluated the error of creatinine and/or cystatin-C based formulas in reflecting real renal function over a wide range of glomerular filtration rate (from advanced chronic kidney disease to hyperfiltration). The error of estimated glomerular filtration rate by any equation was common and wide averaging 30% of real renal function, and larger in patients with measured glomerular filtration rate below 60 mL/min. This led to chronic kidney disease stages misclassification in about 30% of the individuals and failed to detect 25% of the cases with hyperfiltration. Cystatin-C based formulas did not outperform creatinine based equations, and the reliability of more modern algorithms proved to be as poor as older equations. Formulas failed in reflecting renal function in type 2 diabetes mellitus. Caution is needed with the use of these formulas in patients with diabetes, a population at high risk for kidney disease. Whenever possible, the use of a gold standard method to measure renal function is recommended.

scholarly journals P0223AGING CHANGES OF RENAL FUNCTION AND EVALUATION OF DIFFERENT GLOMERULAR FILTRATION RATE ESTIMATION EQUATIONS IN HEALTH PEOPLE IN BEIJING

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lengnan Xu ◽  
Yonghui Mao ◽  
Aiqun Chen ◽  
Ban Zhao
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Age Groups ◽  
The Elderly ◽  
The Body ◽  
True Value ◽  
Age Related

Abstract Background and Aims The kidney is an important organ that removes metabolites and certain wastes and poisons from the body, and retains water and other useful substances through reabsorption. Its aging and function decline have a significant impact on the human health.Rather than simply depending on serum creatinine, glomerular filtration rate (GFR) assessment equation should be given priority in evaluating renal function. Different evaluated GFR (eGFR) equations sometimes have great differences in assessing the true value of GFR, especially for the elderly. The purpose of this study was to analyze the aging changes of renal function in normal people in Beijing and to compare the significance of different eGFR equations in evaluating renal function in Chinese population. Method The age, sex and serum creatinine were recorded in the population who underwent routine physical examination in our hospital from January 2012 to December 2014. Kidney function was assessed by CKD-EPI, MDRD, MDRDc, FAS and BIS equations, respectively. Results A total of 46 713 persons were enrolled in this study, of whom 27 249 (58.33%) were males. They were followed up for 3 years, ranging in age from 16 to 100 years. Both men and women showed age-related change in serum creatinine: serum creatinine and its standard deviation gradually increases parallel with age, indicating that the range of serum creatinine changes in the elderly was larger. Whether male or female, there were differences in eGFR change between different age groups (male: Χ2=141.28, P=0.000; female: Χ2=97.55, P=0.000). For male, eGFR decreased more in the elderly, and it was more common for young people to keep the eGFR constant or increase. However, in female, eGFR remained unchanged in most old people, and increased or decreased in the majority of the young. For all age groups, the ICC was very consistent among the equations, 0.849 for males and 0.817 for females. The whole population was divided into three groups according to serum creatinine &lt; 1mg/dL, &gt; 1mg/dL and &lt; 1.5mg/dL, &gt; 1.5mg/dL. The CKD-EPI equation gave higher stages of CKD than other equations. There was no clear age-related change trend in the 3-year average eGFR change rate of all age groups. For the elderly over 70 years of age, the MDRD and MDRDc equations had higher GFR evaluation results than the other three equations. The BIS equation had the lowest results of all equations. The ICC was very consistent among the equations, 0.966 for males and 0.957 for females. Conclusion we believed that the annual change of GFR varied from person to person and had little to do with age. GFR needed to be calculated more accurately in order to formulate corresponding medical strategies. Those eGFR equations the above-mentioned can be used to evaluate renal function, but the results were very different for different populations and serum creatinine levels. The use of different eGFR equations may lead to large differences in drug dose adjustment and the risk of serious adverse reactions. For the elderly in China, which equation was more suitable was inconclusive and further research was urgently needed.

scholarly journals Estimation of Glomerular Filtration Rate Based on Serum Cystatin C versus Creatinine in a Uruguayan Population

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Inés Lujambio ◽  
Mariana Sottolano ◽  
Leonella Luzardo ◽  
Sebastián Robaina ◽  
Nadia Krul ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Kappa Statistic ◽  
Serum Cystatin C ◽  
Cohen’S Kappa ◽  
Serum Cystatin ◽  
Cohen's Kappa

Background. Estimation of glomerular filtration rate (eGFR) from biomarkers has evolved and multiple equations are available to estimate renal function at bedside.Methods. In a random sample of 119 Uruguayans (54.5% women; 56.2 years (mean)), we used Bland and Altman’s method and Cohen’s kappa statistic to assess concordance on a continuous or categorical (eGFR < 60versus≥60 mL/min/1.73 m2) scale between eGFRcys(reference) and eGFR derived from serum creatinine according to the Modification of Diet in Renal Disease (eGFRmdrd) or the Chronic Kidney Disease Epidemiology Collaboration equations (eGFRepi) or from both serum cystatin C and creatinine (eGFRmix).Results. In all participants, eGFRmdrd, eGFRepi, and eGFRmixwere, respectively, 9.7, 11.5, and 5.6 mL/min/1.73 m2higher (P<0.0001) than eGFRcys. The prevalence of eGFR <60 mL/min/1.73 m2was the highest for eGFRcys(21.8%), intermediate for eGFRmix(11.8%), and the lowest for eGFRmdrd(5.9%) and eGFRepi(3.4%). Using eGFRcysas reference, we found only fair agreement with the equations based on creatinine (Cohen’s kappa statistic 0.15 to 0.23).Conclusion. Using different equations we reached clinically significant differences in the estimation of renal function. eGFRcysprovides lower estimates, resulting in higher prevalence of eGFR <60 mL/min/1.73 m2.

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