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© 2002 by the American Diabetes Association, Inc.
Emerging Treatments and Technologies |
Clinical Usefulness of Cystatin C for the Estimation of Glomerular Filtration Rate in Type 1 Diabetes
Reproducibility and accuracy compared with standard measures and iohexol clearance
1 Oxford Centre for Diabetes, Endocrinology & Metabolism, Oxford, U.K
2 Department of Clinical Biochemistry, Oxford Radcliffe Hospitals, Oxford, U.K
3 Oxford Kidney Unit, Oxford Radcliffe Hospitals, Oxford, U.K
OBJECTIVE—Assessment and follow-up of early renal dysfunction is important in diabetic nephropathy. Plasma creatinine is insensitive for a glomerular filtration rate (GFR) >50 ml/min and creatinine clearance is unwieldy and subject to collection inaccuracies. We aimed to assess the reproducibility, reliability, and accuracy of plasma cystatin C as a measure of GFR ranging from normal to moderate impairment due to type 1 diabetes in the presence of a normal plasma creatinine concentration.
RESEARCH DESIGN AND METHODS—A sensitive immunoturbidimetric cystatin C assay was examined in 29 subjects with type 1 diabetes and 11 nondiabetic subjects. Duplicate measurements of the following were collected from each subject, 2 weeks apart: cystatin C, enzymatic plasma creatinine, 24-h creatinine clearance, GFR estimated from plasma creatinine by the Cockcroft-Gault equation, and iohexol clearance as a gold standard.
RESULTS—Iohexol clearance ranged from 35 to 132 ml · min-1 · 1.73 m-2. Plasma cystatin C compared well with the other clinically used tests. The reliability of cystatin C, as assessed by the discriminant ratio, was superior to creatinine clearance (3.4 vs. 1.5, P < 0.001) and the correlation of cystatin C with iohexol clearance (Rs -0.80) was similar to that of creatinine clearance (Rs -0.74) and superior to that of plasma creatinine and the Cockcroft-Gault estimate (Rs -0.54 and 0.66, respectively). Duplicate estimations were used to provide an unbiased equation to convert plasma cystatin C to GFR.
CONCLUSIONS—Based on this study, cystatin C is a more reliable measure of GFR than creatinine clearance, is more highly correlated with iohexol clearance than plasma creatinine, and is worthy of further investigation as a clinical measure of GFR in type 1 diabetes.
Abbreviations: CV, coefficient of variation • DR, discriminant ratio • GFR, glomerular filtration rate • GFR-CG, GFR calculated by the Cockcroft-Gault method • GFR-IO, GFR as measured by iohexol clearance • SDU, underlying between-subject SD • SDW, within-subject SD
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