Comparison of serum cystatin C, serum creatinine and glomerular filtration rate estimation by CKD-EPI equation in Thai elderly.

Mullika Damrongwiriyakul Mullika Damrongwiriyakul, Sutachat Bijaphala, Somkait Malila, Thava Rerksngarm

Abstract


Chronic kidney disease (CKD) is prevalent in elderly population and commonly identified by using serum creatinine as a classic marker for estimation of glomerular filtration rate (eGFR).  However, serum creatinine has several limitations in detection of renal dysfunction. Many studies showed that serum cystatin C was more effective than serum creatinine to detect renal dysfunction.In the present study, serum cystatin C was studied for its role as a new biomarker for estimating the GFR by using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Blood samples from 429 patients age over 60 years with serum creatinine levels ≤ 1.4 mg/dL were used in this study. Serum creatinine was measured by Jaffe and enzymatic methods and serum cystatin C was measured by particle-enhanced turbidimetric immunoassay (PETIA). It was shown that the mean of creatinine by Jaffe and enzymatic methods were 0.93 and 0.91 mg/dL, respectively and the mean of cystatin C was 1.19 mg/L. Correlation between serum cystatin C with eGFR (r2=0.833) was higher than those between serum creatinine(both Jaffe and enzymatic methods)with eGFR(r2=0.699 and 0.477, respectively). Serum cystatin C is a more sensitive marker than creatinine for the estimation of GFR.Comparisons of the eGFR among the results based on creatinine ,cystatin C and combined creatinine-cystatin C CKD-EPI equations, indicated that the combined creatinine-cystatinC CKD-EPI equation is more suitable for the Thai elderly because the method is more  sensitive and can detectmild, moderate and severe CKD. However, the cost-effectiveness of using this new marker for clinical use should be considered.

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