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Diabetes Care 26:1320, 2003
© 2003 by the American Diabetes Association, Inc.

Letters: Observations
Letter

Performance of Serum Cystatin-C Versus Serum Creatinine in Subjects With Type 1 Diabetes

Martin Buysschaert, MD, PHD1, Ihab Joudi, MD1, Pierre Wallemacq, PHARM BIOL, PHD2 and Michel P. Hermans, MD, PHD1

1 Department of Endocrinology and Nutrition, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium
2 Department of Clinical Biology, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium

Glomerular filtration rate (GFR) is considered the best marker of renal function, and its estimation using inulin or 51Cr-EDTA is considered the "gold standard." Such determination is inconvenient and often replaced by an estimate of creatinine clearance (CrCl) derived from the formula of Cockroft and Gault (CG). Serum cystatin-C was recently proposed as a reliable alternative routine marker of GFR in pediatric, adult, and elderly subjects (1–4). Although Dharnidharka et al. (5) thouroughly review the issue of comparing cystatin-C and creatinine in relation to reference GFR measurements, few reports deal with the comparison of serum creatinine and cystatin-C in diabetic patients (5–9). Odozze et al. (6) suggested that serum cystatin was not superior to creatinine for estimating GFR in type 1 and type 2 diabetic patients with early renal impairment, while others clearly hint toward cystatin-C measurement being a more sensitive and specific GFR marker in type 2 diabetic subjects with normal or slightly reduced GFRs (5–8). Mussap et al. (9) found that cystatin-C was more accurate than creatinine in discriminating diabetic subjects according to 51Cr-EDTA GFR.

In the November 2002 issue of Diabetes Care, Tan et al. (10) reported the clinical usefulness of cystatin-C for GFR estimation in subjects with type 1 diabetes using iohexol clearance as the "gold standard" GFR measurement and discriminant ratio (DR) methodology (10,11). Using the same DR approach (11), we assessed, from intra- and intersubject variability, the performance of cystatin-C (particle-enhanced immunonephelometric method, N Latex Cystatin-C; Dade Behring) in 46 subjects with type 1 diabetes spanning a wide range of kidney function, as compared with that of serum creatinine (8). Age and diabetes duration were 45 ± 16 and 18 ± 12 years, respectively, BMI 24 ± 3 kg/m2, and HbA1c 8.7 ± 1.5%. Median CrCl estimated by the CG formula was 92 ml/min (range: 15–149; 25–75th percentile: 81–110), adjusted to a body surface area of 1.73 m2, with normo- (CG 70–120 ml/min), hyper- (CG >120), and hypofiltration (CG <70) present in 63, 20, and 17%, respectively. Serum creatinine levels were 1.01 ± 0.73 and 1.02 ± 1.00 mg/dl and cystatin-C 1.00 ± 0.67 and 0.98 ± 0.73 mg/l on days 1 and 2, respectively. A close linear relationship was observed between means of duplicates for creatinine and cystatin-C (Pearson product-moment correlation 0.97). The DR (ratio of the underlying between-subject to within-subject SD) was 3.92 for creatinine and 9.09 for cystatin-C (P < 0.0001), implying superior discriminating ability for cystatin-C. Once adjusted for attenuation, measured Pearson product-moment correlation increased to 1.00. The unbiased linear regression equation between methods had a slope of 0.83 and an intercept at 0.16. We conclude that serum cystatin-C better discriminates among a population of type 1 diabetic patients with regard to their estimated GFR, as compared with conventional serum creatinine measurement, and recommend its routine use for estimating kidney function in this population.

Footnotes

Address correspondence to Prof. M.P. Hermans, MD, PhD, DipNatSci, Service d’Endocrinologie et Nutrition, Cliniques Universitaires St. Luc, Avenue Hippocrate 54, UCL 54.74, B-1200 Bruxelles, Belgique. E-mail: michel.hermans{at}diab.ucl.ac.be.

References

  1. Newman D, Thakkar H, Edwards R, Wilkie M, White T, Grubb A, Price C: Serum cystatin-C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine. Kidney Int 47: 312–318, 1995[Medline]
  2. Fliser D, Ritz E: Serum cystatin-C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 37: 79–83, 2001[Medline]
  3. Dworkin LD: Serum cystatin-C as a marker of glomerular filtration rate. Curr Opin Nephrol Hypertens 10: 551–553, 2001[Medline]
  4. Donadio C, Lucchesi A: Serum cystatin as a marker of glomerular filtration rate. Am J Kidney Dis 37: 448–456, 2001[Medline]
  5. Dharnidharka VR, Kwon C, Stevens G: Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 40: 221–226, 2002[Medline]
  6. Oddoze C, Morange S, Portugal H, Berland Y, Dussol B: Cystatin-C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes. Am J Kidney Dis 38: 310–316, 2001[Medline]
  7. Harmoinen A, Kouri T, Wirta O, Lehtimaki T, Rantalaiho V, Turjanmaa V, Pasternack A: Evaluation of plasma cystatin-C as a marker for glomerular filtration rate in patients with type 2 diabetes. Clinical Nephrol 52: 363–370, 1999
  8. Piwowar A, Knapik-Kordecka M, Buczynska H, Warwas M: Plasma cystatin-C concentration in non-insulin-dependent diabetes mellitus: relation with nephropathy. Arch Immunol Ther Exp (Warsz) 47: 327–331, 1999
  9. Mussap M, Dalla Vestra M, Fioretto P, Saller A, Varagnolo M, Nosadini R, Plebani M: Cystatin C is a more sensitive marker than serum creatinine for the estimation of GFR in type 2 diabetic subjects. Kidney Int 61: 1453–1461, 2002[Medline]
  10. Tan GD, Lewis AV, James TJ, Altmann P, Taylor RP, Levy JC: 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. Diabetes Care 25: 2004–2009, 2002[Abstract/Free Full Text]
  11. Levy J, Morris R, Hammersley M, Turner R: Discrimination, adjusted correlation, and equivalence of imprecise tests: application to glucose tolerance. Am J Physiol 276: E365–E375, 1999[Abstract/Free Full Text]

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