Thai Journal of Gastroenterology

Article :
Estimating Glomerular Filtration Rate with Creatinine and Cystatin C-based Equations in Cirrhotic Patients

Author :
Luangchosiri C
Meemaew P
Sobhonslidsuk A
Klyprayong P
Sangcakul A
Chittamma A
Kuhiran C
Vanavanan S
Kitiyakara C

Abstract :
Objectives: To assess the performance of estimated GFR (eGFR) equations based on serum creatinine (Cr) and cystatin C (Cys) with measured GFR (mGFR) in cirrhotic patients. Materials and Methods: Cirrhotic patients were enrolled. The mGFR was calculated from plasma iohexol clearance using a two compartment method. The plasma iohexol concentration was measured at 10-time points between 5-300 minutes after injection of 5 mL of iohexol. Baseline Cr and Cys were transformed into different eGFR values using previously published equations. Pearson’s correlation and Bland-Altman analysis were used to analyze the performance of each eGFR equation in comparison to mGFR. Results: Twenty-one cirrhotic patients were enrolled. Mean (SD) of serum Cr and Cys were 0.88 (0.3) mg/dL and 1.04 (0.4) mg/L. GFR (mL/minute/1.73m2) were mGFR 80.50 (24.9), MDRD 96.9 (40.8), Cockcroft- Gault 86.7 (31.9), CKD-EPI 76.1 (24.5), Cys Hoek 79.8 (21.9), and Cys Steven 81.7 (24.8). The eGFR from all equations were found to correlate with mGFR, but with low correlation coefficients. The accuracy at 30% ranged from 59.1 (for MDRD) to 72.7 % (for Cys equations). Conclusions: The eGFR by using Cr or Cys-based equations correlated with mGFR, but may be inaccurate in some individuals. In cirrhotic patients, MDRD is not recommended for GFR estimation because of larger bias and lower accuracy. There is no clear advantage to use Cys-based equations over Cr-based CKD-EPI or Cockcroft-Gault equations.

Keyword :
Glomerular filtration rate, creatinine clearance, cystatin C,cirrhosis, Cockcroft-Gault equation, MDRD equation, CKD-EPI equation, Hoek equation

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