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Diabetes Care Publish Ahead of Print published online ahead of print March 4, 2008
DOI: 10.2337/dc07-1588
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Original Research

Serial Measurements of Cystatin C are More Accurate than Creatinine-based Methods in Detecting Declining Renal Function in Type 1 Diabetes

Erosha Premaratne, MBBS, FRACP1, Richard MacIsaac, PhD, MBBS, FRACP1, Sue Finch, PhD2, Sianna Panagiotopoulos, PhD1, Elif Ekinci, MBBS1 and George Jerums, MBBS,FRACP,MD1

1Endocrine Centre/Austin Health, Medicine/University of Melbourne, Melbourne, Australia
2Statistical Consulting Centre, University of Melbourne, Australia

ABSTRACT

Objective: Cystatin C and creatinine-based methods were compared with 99mTc-DTPA plasma clearance (isotopic Glomerular Filtration Rate or iGFR) for detecting declining renal function.

Research Design and Methods: GFR was monitored over a mean of 10.1 years in 85 subjects with type 1 diabetes (average of 5.6 measurements per individual). Baseline mean iGFR of the cohort was 106.1+2.6ml/min/1.73m2. The rates of decline in GFR ({Delta}GFR) were derived using linear regression.

Results: In the 19/85 subjects with declining renal function (i.e. {Delta}iGFR>3.3ml/min/1.73m2 per year), {Delta}GFR (ml/min/1.73m2 per year) was: 6.5 by iGFR and 4.2 by 104/creatinine, 3.6 by Cockcroft-Gault formula, 3.4 by MDRD-6 -equation and 3.5 by MDRD-4 variable-equation (p<0.01 versus iGFR). In comparison, {Delta}GFR was 6.1 using the formula Cys-GFR=(86.7/cystatin C concentration)–4.2 (ns).

Conclusions: Cystatin C was more accurate in detecting decline in renal function than creatinine-based methods in this population of subjects with Type 1 and a normal mean baseline GFR.


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