Update on cystatin C: incorporation into clinical practice

Abstract

Kidney function monitoring using creatinine-based glomerular filtration rate estimation is a routine part of clinical practice. Emerging evidence has shown that cystatin C may improve classification of glomerular filtration rate for defining chronic kidney disease in certain clinical populations and assist in understanding the complications of chronic kidney disease. In this review and update, we summarize the overall literature on cystatin C, critically evaluate recent high-impact studies, highlight the role of cystatin C in recent kidney disease guidelines, and suggest a practical approach for clinicians to incorporate cystatin C into practice. We conclude by addressing frequently asked questions related to implementing cystatin C use in a clinical setting.

Keywords: Cystatin C; chronic kidney disease; glomerular filtration rate (GFR) estimation.

Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Cystatin C versus Creatinine as markers of GFR. (A) Scatter plot of correlation coefficients (r) for 1/Cys C and 1/Cr with measured GFR. Horizontal line represents the cumulative mean r of all studies analyzed. (B) Scatter plot of ROC-plot AUC values for Cys C and Cr. Horizontal line represents the cumulative mean of all 14 data sets. Adapted and reproduced from Dharnidharka et al with permission of the National Kidney Foundation.

Figure 2

Proportion of GFR Variance Explained by the Filtration Markers (creatinine and cystatin C) and Demographic Factors (age and sex, shown in dark grey) in the Berlin Initiative Study.