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BACKGROUND/AIMS: Serum creatinine has several drawbacks as marker of glomerular filtration rate (GFR), and therefore serum cystatin C has been proposed as a more optimal GFR marker. Previous reports have suggested benefits of serum cystatin C measurements in patients with renal transplants. The purpose of the present study was to evaluate the diagnostic accuracy of cystatin C measurements compared with enzymatic creatinine measurements as serum markers of GFR (established from plasma clearance of iohexol) in a large cohort of stable renal transplant recipients and in the early postoperative phase. METHODS: Renal transplant patients (n = 125) with stable graft function were evaluated from reciprocals of serum creatinine and cystatin C compared with iohexol clearance. Fourteen patients were examined immediately after the onset of renal function. Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. RESULTS: In stable renal transplant recipients, serum cystatin C showed a significantly (p = 0.033) closer correlation (r = 0.89 or 79% co-variance) with iohexol clearance than did serum creatinine (r = 0.81 or 66% co-variance). Using the chi(2) test and a cut-off at 60 ml/min/1.73 m(2), serum cystatin C levels demonstrated significantly higher sensitivity for early GFR impairment (p = 0.0045) compared with serum creatinine measurements. On the first day after transplantation, serum cystatin C fell more rapidly than serum creatinine. CONCLUSION: Serum cystatin C levels correlate significantly closer to accurate measurements of GFR and are significantly more sensitive to detect early GFR impairment than enzymatic measurements of creatinine in serum.

Original publication

DOI

10.1159/000071287

Type

Journal article

Journal

Nephron Physiol

Publication Date

2003

Volume

94

Pages

p19 - p27

Keywords

Adult, Aged, Amidohydrolases, Biomarkers, Cohort Studies, Creatinine, Cystatin C, Cystatins, Glomerular Filtration Rate, Humans, Iohexol, Kidney Failure, Chronic, Kidney Glomerulus, Kidney Transplantation, Male, Middle Aged, Sensitivity and Specificity