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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. G.D. Tan, MRCP, DTM&H1,
  2. A.V. Lewis, MSC2,
  3. T.J. James, MSC, FIBMS2,
  4. P. Altmann, MD, FRCP3,
  5. R.P. Taylor, PHD, FRCPATH2 and
  6. J.C. Levy, MD, FRCP1
  1. 1Oxford Centre for Diabetes, Endocrinology & Metabolism, Oxford, U.K
  2. 2Department of Clinical Biochemistry, Oxford Radcliffe Hospitals, Oxford, U.K
  3. 3Oxford Kidney Unit, Oxford Radcliffe Hospitals, Oxford, U.K
    Diabetes Care 2002 Nov; 25(11): 2004-2009. https://doi.org/10.2337/diacare.25.11.2004
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      Figure 1—

      Bland-Altmann plots illustrating within-subject variability of cystatin C, plasma creatinine concentration, creatinine clearance, Cockcroft-Gault estimation of GFR, and iohexol clearance. The vertical axis represents the difference of two duplicate tests (second minus first). In each case, the ranges of the vertical and horizontal axes are equal. The dotted lines represent 10% deviations above and below the mean value.

    • Figure 2—
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      Figure 2—

      Scattergram of the reciprocal of cystatin C versus iohexol clearance expressed per 1.73 m2. Each point represents the mean of two duplicate assessments. Open circles represent nondiabetic subjects and solid diamonds represent diabetic subjects. The dashed line represents the unbiased line of equivalence: the estimate of the underlying linear relationship between the two values, calculated as detailed in the text.

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    • Table 1—

      Baseline characteristics of patients

      No diabetesType 1 diabetes
      No proteinuriaMicroalbuminuriaProteinuria
      Number of subjects1110109
      Male:female6:55:55:55:4
      Age (years)43 ± 1146 ± 1360 ± 1054 ± 15
      Duration of diabetes (years)—24 ± 1428 ± 1326 ± 13
      BMI (kg/m2)24.3 ± 2.925 ± 329.4 ± 5.327.7 ± 3.5
      HbA1c (%)—7.9 ± 1.29.1 ± 1.610.3 ± 1.6
      • Data are means ± SD.

    • Table 2—

      Measures of reproducibility

      Mean (range)Within-subject SDBetween-subject SDWithin-subject CVDiscriminant ratio (95% CI)Discriminant ratio: P versus iohexol clearanceDiscriminant ratio: P versus cystatin C
      Plasma creatinine (μmol/l)75 (39–131)7.419.09.9%2.5 (1.9–3.2)<0.0010.065
      Creatinine clearance (ml · min · 1.73 m−2)91 (40–166)17.629.619.2%1.5 (1.1–2.1)<0.001<0.001
      GFR-CG (ml · min · 1.73 m−2)102 (37–203)10.133.79.9%3.3 (2.5–4.2)<0.0010.43
      Cystatin C (mg/l)0.98 (0.52–2.03)0.10.38.9%3.4 (2.6–4.4)<0.001—
      Iohexol clearance (ml · min · 1.73 m−2)84 (35–132)4.723.25.6%4.9 (3.9–6.3)——
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    Diabetes Care: 25 (11)

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    November 2002, 25(11)
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    Clinical Usefulness of Cystatin C for the Estimation of Glomerular Filtration Rate in Type 1 Diabetes
    G.D. Tan, A.V. Lewis, T.J. James, P. Altmann, R.P. Taylor, J.C. Levy
    Diabetes Care Nov 2002, 25 (11) 2004-2009; DOI: 10.2337/diacare.25.11.2004

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    Clinical Usefulness of Cystatin C for the Estimation of Glomerular Filtration Rate in Type 1 Diabetes
    G.D. Tan, A.V. Lewis, T.J. James, P. Altmann, R.P. Taylor, J.C. Levy
    Diabetes Care Nov 2002, 25 (11) 2004-2009; DOI: 10.2337/diacare.25.11.2004
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