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

  1. Erosha Premaratne, MBBS, FRACP1,
  2. Richard J. MacIsaac, PHD, MBBS, FRACP1,
  3. Sue Finch, PHD2,
  4. Sianna Panagiotopoulos, PHD1,
  5. Elif Ekinci, MBBS1 and
  6. George Jerums, MBBS, FRACP, MD1
  1. 1Endocrine Centre, Austin Health, University of Melbourne, Melbourne, Australia
  2. 2Statistical Consulting Centre, University of Melbourne, Melbourne, Australia
  1. Corresponding author: Dr. Erosha Premaratne, Endocrine Centre, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia. E-mail: erosha{at}aanet.com.au

Abstract

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 (ΔGFR) were derived using linear regression.

RESULTS—In 19 of 85 subjects with declining renal function (i.e., ΔiGFR >3.3 ml/min per 1.73 m2 per year), ΔGFR (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, ΔGFR 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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 4 March 2008. DOI: 10.2337/dc07-1588.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted January 28, 2008.
    • Received August 11, 2007.
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  1. Published online before print March 4, 2008, doi: 10.2337/dc07-1588 Diabetes Care May 2008 vol. 31 no. 5 971-973
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