BACKGROUND: Conventional estimates of glomerular dysfunction, including serum creatinine and creatinine clearance, are inadequate in older people. In this study we have compared the diagnostic accuracy of a novel test of kidney disease, cystatin C, against these markers in older patients with a range of renal function. METHODS: Fifty-three patients (mean age 79.6 years, range 69-92 years) with a variety of medical diagnoses were recruited via outpatient clinics. Exclusion criteria included active rheumatoid disease, known current malignancy, renal replacement therapy/renal transplantation and cognitive impairment. (51)Cr-EDTA was used as the reference method against which the other markers of glomerular filtration rate were compared using regression analyses. RESULTS: The best fit with glomerular filtration rate was given by Cockcroft and Gault calculated clearance (R(2) = 0.83), followed by serum cystatin C (R(2) = 0.79), serum creatinine (R(2) = 0.76) and creatinine clearance (R(2) = 0.73). The accuracy for glomerular filtration rate prediction was poor for all markers. Serum cystatin C detected nearly all patients with mild renal impairment whereas serum creatinine only detected half of these cases. Regression modelling predicted that the upper limit of normal for serum cystatin C would be exceeded as glomerular filtration rate fell below 64 mL/min/1.73 m(2), compared with 44 mL/min/1.73 m(2) for serum creatinine. CONCLUSION: Serum cystatin C is a simple and sensitive screening test for kidney dysfunction in older people.
BACKGROUND: Conventional estimates of glomerular dysfunction, including serum creatinine and creatinine clearance, are inadequate in older people. In this study we have compared the diagnostic accuracy of a novel test of kidney disease, cystatin C, against these markers in older patients with a range of renal function. METHODS: Fifty-three patients (mean age 79.6 years, range 69-92 years) with a variety of medical diagnoses were recruited via outpatient clinics. Exclusion criteria included active rheumatoid disease, known current malignancy, renal replacement therapy/renal transplantation and cognitive impairment. (51)Cr-EDTA was used as the reference method against which the other markers of glomerular filtration rate were compared using regression analyses. RESULTS: The best fit with glomerular filtration rate was given by Cockcroft and Gault calculated clearance (R(2) = 0.83), followed by serum cystatin C (R(2) = 0.79), serum creatinine (R(2) = 0.76) and creatinine clearance (R(2) = 0.73). The accuracy for glomerular filtration rate prediction was poor for all markers. Serum cystatin C detected nearly all patients with mild renal impairment whereas serum creatinine only detected half of these cases. Regression modelling predicted that the upper limit of normal for serum cystatin C would be exceeded as glomerular filtration rate fell below 64 mL/min/1.73 m(2), compared with 44 mL/min/1.73 m(2) for serum creatinine. CONCLUSION: Serum cystatin C is a simple and sensitive screening test for kidney dysfunction in older people.
Authors: Marquis Hawkins; Anne B Newman; Magdalena Madero; Kushang V Patel; Michael G Shlipak; Jennifer Cooper; Kirsten L Johansen; Sankar D Navaneethan; Ronald I Shorr; Eleanor M Simonsick; Linda F Fried Journal: J Phys Act Health Date: 2014-04-17
Authors: Jonathan G Amatruda; Ronit Katz; Carmen A Peralta; Michelle M Estrella; Harini Sarathy; Linda F Fried; Anne B Newman; Chirag R Parikh; Joachim H Ix; Mark J Sarnak; Michael G Shlipak Journal: J Am Geriatr Soc Date: 2020-12-10 Impact factor: 5.562
Authors: Gregory Levin; Bryan Kestenbaum; Yii-Der Ida Chen; David R Jacobs; Bruce M Psaty; Jerome I Rotter; David S Siscovick; Ian H de Boer Journal: Am J Epidemiol Date: 2010-10-20 Impact factor: 4.897
Authors: Clara Y Jones; Camille A Jones; Ira B Wilson; Tamsin A Knox; Andrew S Levey; Donna Spiegelman; Sherwood L Gorbach; Frederick Van Lente; Lesley A Stevens Journal: Am J Kidney Dis Date: 2008-05-02 Impact factor: 8.860