1. Serial Measurements of Cystatin C Are More Accurate Than Creatinine-Based Methods in Detecting Declining Renal Function in Type 1 Diabetes
- Author
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Richard J MacIsaac, Sue Finch, George Jerums, Erosha Premaratne, Elif I Ekinci, and Sianna Panagiotopoulos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Population ,Urology ,Renal function ,Kidney Function Tests ,urologic and male genital diseases ,White People ,chemistry.chemical_compound ,Asian People ,Internal medicine ,Diabetes mellitus ,Linear regression ,Internal Medicine ,Humans ,Medicine ,Diabetic Nephropathies ,Cystatin C ,education ,reproductive and urinary physiology ,Aged ,Advanced and Specialized Nursing ,Creatinine ,Type 1 diabetes ,education.field_of_study ,biology ,business.industry ,Australia ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Cystatins ,female genital diseases and pregnancy complications ,Diabetes Mellitus, Type 1 ,Endocrinology ,chemistry ,biology.protein ,Female ,business ,Glomerular Filtration Rate ,Kidney disease - 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.
- Published
- 2008
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