Barr ELM

Maple-Brown, Louise

Barzi F

Hughes Wagadagam , Jaquelyne

Jerums G

Ekinci EI

Jones GRD

Ellis AG

Lawton, P

Sajiv, Cherian

Majoni, Sandawana William

Brown ADH

Hoy WE

O'Dea K

Cass A

MacIsaac RJ

2017-04-01

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC+cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m2; 95% CI 13.3-16.4, p<0.001) and eGFRcysC+cr (10.3; 8.8-11.5, p<0.001) compared to eGFRcr (5.4; 3.0-7.2). Accuracy was lower for eGFRcysC (80.3%; 76.7-83.5, p<0.001) but not for eGFRcysC+cr (91.9; 89.3-94.0, p=0.29) compared to eGFRcr (90.0; 87.2-92.4). Precision was comparable for all equations. The performance of eGFRcysC deteriorated across increasing levels of c-reactive protein. Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians.

Menzies School of Health Research, Darwin, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia. Electronic address: Elizabeth.Barr@menzies.edu.au..

Menzies School of Health Research, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Australia..

Menzies School of Health Research, Darwin, Australia..

Menzies School of Health Research, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Australia..

Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia..

Menzies School of Health Research, Darwin, Australia; Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia..

Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia..

SydPath, St Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia..

Menzies School of Health Research, Darwin, Australia..

Northern Territory Renal Services, Darwin, Australia; Northern Territory Department of Health, Darwin, Australia..

Division of Medicine, Royal Darwin Hospital, Australia; Division of Nephrology, Royal Darwin Hospital, Australia..

South Australian Health and Medical Research Institute, Adelaide, Australia; University of South Australia, Adelaide, Australia..

University of Queensland, Brisbane, Australia..

University of South Australia, Adelaide, Australia..

Menzies School of Health Research, Darwin, Australia..

St Vincent's Hospital Melbourne, Melbourne, Australia..

Clin Biochem . 2017 Apr;50(6):301-308. doi: 10.1016/j.clinbiochem.2016.11.024. Epub 2016 Nov 25.

https://pubmed.ncbi.nlm.nih.gov/27894952/?otool=iaurydwlib

https://hdl.handle.net/10137/5306

CKD-EPI equation

Creatinine

Cystatin C

GFR

Indigenous

Adolescent

Adult

Algorithms

Australia

C-Reactive Protein

Creatinine

Cross-Sectional Studies

Cystatin C

Female

Humans

Kidney Function Tests

Male

Middle Aged

Population Groups

Renal Insufficiency, Chronic

Young Adult

Glomerular Filtration Rate

Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study.

Journal Article

Publication