Creatinine-based and cystatin C-based GFR estimating equations and their non-GFR determinants in kidney transplant recipients

Mira Keddis, Hatem Amer, Nikolay Voskoboev, Walter K Kremers, Andrew D Rule, John C Lieske

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10 Citations (Scopus)

Abstract

Background and objectives eGFR equations have been evaluated in kidney transplant recipients with variable performance.We assessed the performance of the Modification ofDiet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors. Design, setting, participants, & measurements A cross-sectional cohort of 1139 kidney transplant recipients >1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30% of measured GFR)were assessed. Interaction of each cardiovascular risk factorwith eGFR relative tomeasured GFR was determined. Results Median measured GFR was 55.0 ml/min per 1.73 m2. eGFR creatinine overestimated measured GFR by 3.1% (percentage of estimates within 30% of measured GFR of 80.4%), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2%(percentage of estimateswithin 30%ofmeasured GFR of 80.4%). eGFR cystatin C underestimated measured GFR by 213.7% (percentage of estimates within 30% of measured GFR of 77.1%), and eGFR creatinine-cystatinCunderestimatedmeasuredGFR by28.1% (percentage of estimates within 30%ofmeasured GFR of 86.5%). Lower measured GFR associatedwith older age,women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification ofDiet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C. Conclusions Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.

Original languageEnglish (US)
Pages (from-to)1640-1649
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number9
DOIs
StatePublished - 2016

Fingerprint

Cystatin C
Creatinine
Kidney
Hemoglobins
Iothalamic Acid
Transplants
Diet Therapy
Troponin T
Transplant Recipients
Chronic Renal Insufficiency
Proteinuria
Dialysis
Albumins
Epidemiology
Triglycerides
Obesity
Smoking

Keywords

  • Cardiovascular Diseases
  • Creatinine
  • Cystatin C
  • Diabetes mellitus
  • Glomerular filtration rate
  • Iothalamic Acid
  • Kidney transplantation
  • Obesity
  • Proteinuria
  • Risk factors
  • Smoking
  • Triglycerides

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

@article{4c740de047d945939fba1647d4a991cf,
title = "Creatinine-based and cystatin C-based GFR estimating equations and their non-GFR determinants in kidney transplant recipients",
abstract = "Background and objectives eGFR equations have been evaluated in kidney transplant recipients with variable performance.We assessed the performance of the Modification ofDiet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors. Design, setting, participants, & measurements A cross-sectional cohort of 1139 kidney transplant recipients >1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30{\%} of measured GFR)were assessed. Interaction of each cardiovascular risk factorwith eGFR relative tomeasured GFR was determined. Results Median measured GFR was 55.0 ml/min per 1.73 m2. eGFR creatinine overestimated measured GFR by 3.1{\%} (percentage of estimates within 30{\%} of measured GFR of 80.4{\%}), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2{\%}(percentage of estimateswithin 30{\%}ofmeasured GFR of 80.4{\%}). eGFR cystatin C underestimated measured GFR by 213.7{\%} (percentage of estimates within 30{\%} of measured GFR of 77.1{\%}), and eGFR creatinine-cystatinCunderestimatedmeasuredGFR by28.1{\%} (percentage of estimates within 30{\%}ofmeasured GFR of 86.5{\%}). Lower measured GFR associatedwith older age,women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification ofDiet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C. Conclusions Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.",
keywords = "Cardiovascular Diseases, Creatinine, Cystatin C, Diabetes mellitus, Glomerular filtration rate, Iothalamic Acid, Kidney transplantation, Obesity, Proteinuria, Risk factors, Smoking, Triglycerides",
author = "Mira Keddis and Hatem Amer and Nikolay Voskoboev and Kremers, {Walter K} and Rule, {Andrew D} and Lieske, {John C}",
year = "2016",
doi = "10.2215/CJN.11741115",
language = "English (US)",
volume = "11",
pages = "1640--1649",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "9",

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TY - JOUR

T1 - Creatinine-based and cystatin C-based GFR estimating equations and their non-GFR determinants in kidney transplant recipients

AU - Keddis, Mira

AU - Amer, Hatem

AU - Voskoboev, Nikolay

AU - Kremers, Walter K

AU - Rule, Andrew D

AU - Lieske, John C

PY - 2016

Y1 - 2016

N2 - Background and objectives eGFR equations have been evaluated in kidney transplant recipients with variable performance.We assessed the performance of the Modification ofDiet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors. Design, setting, participants, & measurements A cross-sectional cohort of 1139 kidney transplant recipients >1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30% of measured GFR)were assessed. Interaction of each cardiovascular risk factorwith eGFR relative tomeasured GFR was determined. Results Median measured GFR was 55.0 ml/min per 1.73 m2. eGFR creatinine overestimated measured GFR by 3.1% (percentage of estimates within 30% of measured GFR of 80.4%), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2%(percentage of estimateswithin 30%ofmeasured GFR of 80.4%). eGFR cystatin C underestimated measured GFR by 213.7% (percentage of estimates within 30% of measured GFR of 77.1%), and eGFR creatinine-cystatinCunderestimatedmeasuredGFR by28.1% (percentage of estimates within 30%ofmeasured GFR of 86.5%). Lower measured GFR associatedwith older age,women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification ofDiet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C. Conclusions Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.

AB - Background and objectives eGFR equations have been evaluated in kidney transplant recipients with variable performance.We assessed the performance of the Modification ofDiet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors. Design, setting, participants, & measurements A cross-sectional cohort of 1139 kidney transplant recipients >1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30% of measured GFR)were assessed. Interaction of each cardiovascular risk factorwith eGFR relative tomeasured GFR was determined. Results Median measured GFR was 55.0 ml/min per 1.73 m2. eGFR creatinine overestimated measured GFR by 3.1% (percentage of estimates within 30% of measured GFR of 80.4%), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2%(percentage of estimateswithin 30%ofmeasured GFR of 80.4%). eGFR cystatin C underestimated measured GFR by 213.7% (percentage of estimates within 30% of measured GFR of 77.1%), and eGFR creatinine-cystatinCunderestimatedmeasuredGFR by28.1% (percentage of estimates within 30%ofmeasured GFR of 86.5%). Lower measured GFR associatedwith older age,women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification ofDiet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C. Conclusions Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.

KW - Cardiovascular Diseases

KW - Creatinine

KW - Cystatin C

KW - Diabetes mellitus

KW - Glomerular filtration rate

KW - Iothalamic Acid

KW - Kidney transplantation

KW - Obesity

KW - Proteinuria

KW - Risk factors

KW - Smoking

KW - Triglycerides

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U2 - 10.2215/CJN.11741115

DO - 10.2215/CJN.11741115

M3 - Article

VL - 11

SP - 1640

EP - 1649

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 9

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