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Serial Measurements of Cystatin C Are More Accurate Than Creatinine-Based Methods in Detecting Declining Renal Function in Type 1 Diabetes

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

Corresponding author: Dr. Erosha Premaratne, Endocrine Centre, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia. E-mail: erosha{at}aanet.com.au

OBJECTIVE—Cystatin C–and creatinine-based methods were compared with ^99m-technetium-diethylene-triamine-penta-acetic acid (^99mTc-DTPA) plasma clearance (isotopic glomerular filtration rate [iGFR]) for detecting declining renal function.

RESEARCH DESIGN AND METHODS—Glomerular filtration rate (GFR) was monitored over a mean of 10.1 years in 85 subjects with type 1 diabetes (with an average of 5.6 measurements per individual). Baseline mean ± SD iGFR of the cohort was 106.1 ± 2.6 ml/min per 1.73 m². The rates of decline in GFR (GFR) were derived using linear regression.

RESULTS—In 19 of 85 subjects with declining renal function (i.e., iGFR >3.3 ml/min per 1.73 m² per year), GFR (ml/min per 1.73 m² per year) was 6.5 by iGFR, 4.2 by 10⁴/creatinine, 3.6 by Cockcroft-Gault formula, 3.4 by the Modification of Diet in Renal Disease (MDRD)-6 equation, and 3.5 by the MDRD-4 variable equation (P < 0.01 vs. iGFR). In comparison, GFR was 6.1 using the formula Cys-GFR = (86.7/cystatin C concentration) – 4.2 (not significant).

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

Abbreviations: GFR, glomerular filtration rate • iGFR, isotopic GFR • MDRD, Modification of Diet in Renal Disease • ^99mTc-DTPA, ^99m-technetium-diethylene-triamine-penta-acetic acid

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