Alina M Allen1, W Ray Kim, Joseph J Larson, Colin Colby, Terry M Therneau, Andrew D Rule. 1. 1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 2 Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA. 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. 4 Division of Nephrology, Mayo Clinic, Rochester, MN.
Abstract
BACKGROUND/AIMS: Chronic kidney disease (CKD) is an important comorbidity after liver transplantation (LT); however, reliable tools with which to evaluate these patients are limited. In this work, we examine the extent to which the addition of serum cystatin C improves glomerular filtration rate (GFR) estimation and mortality prediction, in comparison to various GFR-estimating equations. METHODS: The GFR was measured in LT recipients by iothalamate clearance. Concurrent serum cystatin C was assayed in banked serum samples. Performance of GFR-estimating equations with and without cystatin C, including the modification of diet in renal disease and CKD-epidemiology collaboration formulas was assessed. The proportional hazards regression analysis was performed to determine the association between serum cystatin C and mortality. RESULTS: A total of 586 iothalamate results were obtained in 401 patients after a mean of 4 years after LT. When compared to measured GFR, the formula with both creatinine and cystatin C, namely, CKD-epidemiology cr-cys, outperformed those with either marker alone. Performance of creatinine-based models was similar to one another. Serum cystatin C, by itself or as a part of an estimated GFR, was a significant predictor of mortality. CONCLUSIONS: Serum cystatin C has an important role in enhancing accuracy of GFR estimation and predicting mortality in LT recipients.
BACKGROUND/AIMS: Chronic kidney disease (CKD) is an important comorbidity after liver transplantation (LT); however, reliable tools with which to evaluate these patients are limited. In this work, we examine the extent to which the addition of serum cystatin C improves glomerular filtration rate (GFR) estimation and mortality prediction, in comparison to various GFR-estimating equations. METHODS: The GFR was measured in LT recipients by iothalamate clearance. Concurrent serum cystatin C was assayed in banked serum samples. Performance of GFR-estimating equations with and without cystatin C, including the modification of diet in renal disease and CKD-epidemiology collaboration formulas was assessed. The proportional hazards regression analysis was performed to determine the association between serum cystatin C and mortality. RESULTS: A total of 586 iothalamate results were obtained in 401 patients after a mean of 4 years after LT. When compared to measured GFR, the formula with both creatinine and cystatin C, namely, CKD-epidemiology cr-cys, outperformed those with either marker alone. Performance of creatinine-based models was similar to one another. Serum cystatin C, by itself or as a part of an estimated GFR, was a significant predictor of mortality. CONCLUSIONS: Serum cystatin C has an important role in enhancing accuracy of GFR estimation and predicting mortality in LT recipients.
Authors: Thomas A Gonwa; Linda Jennings; Martin L Mai; Paul C Stark; Andrew S Levey; Goran B Klintmalm Journal: Liver Transpl Date: 2004-02 Impact factor: 5.799
Authors: Alina M Allen; W Ray Kim; Terry M Therneau; Joseph J Larson; Julie K Heimbach; Andrew D Rule Journal: J Hepatol Date: 2014-04-05 Impact factor: 25.083
Authors: Andrew D Rule; Hiie M Gussak; Gregory R Pond; Erik J Bergstralh; Mark D Stegall; Fernando G Cosio; Timothy S Larson Journal: Am J Kidney Dis Date: 2004-01 Impact factor: 8.860
Authors: Otto Schück; Halima Gottfriedova; Jan Maly; Antonin Jabor; Milena Stollova; Iva Bruzkova; Jelena Skibova; Miroslav Ryska; Julius Spicak; Pavel Trunecka; Jana Novakova Journal: Liver Transpl Date: 2002-07 Impact factor: 5.799
Authors: Akinlolu O Ojo; Philip J Held; Friedrich K Port; Robert A Wolfe; Alan B Leichtman; Eric W Young; Julie Arndorfer; Laura Christensen; Robert M Merion Journal: N Engl J Med Date: 2003-09-04 Impact factor: 91.245