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Chronic kidney disease staging with cystatin C or creatinine-based formulas: flipping the coin
- Source :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 34(2)
- Publication Year :
- 2018
-
Abstract
- Background Chronic kidney disease (CKD) affects 10-13% of the population worldwide. CKD classification stratifies patients in five stages of risk for progressive renal disease based on estimated glomerular filtration rate (eGFR) by formulas and albuminuria. However, the reliability of formulas to reflect real renal function is a matter of debate. The effect of the error of formulas in the CKD classification is unclear, particularly for cystatin C-based equations. Methods We evaluated the reliability of a large number of cystatin C and/or creatinine-based formulas in the definition of the stages of CKD in 882 subjects with different clinical situations over a wide range of glomerular filtration rates (GFRs) (4.2-173.7 mL/min). Results Misclassification was a constant for all 61 formulas evaluated and averaged 50% for creatinine-based and 35% for cystatin C-based equations. Most of the cases were misclassified as one stage higher or lower. However, in 10% of the subjects, one stage was skipped and patients were classified two stages above or below their real stage. No clinically relevant improvement was observed with cystatin C-based formulas compared with those based on creatinine. Conclusions The error in the classification of CKD stages by formulas was extremely common. Our study questions the reliability of both cystatin C and creatinine-based formulas to correctly classify CKD stages. Thus the correct classification of CKD stages based on estimated GFR is a matter of chance. This is a strong limitation in evaluating the severity of renal disease, the risk for progression and the evolution of renal dysfunction over time.
- Subjects :
- Adult
Male
Risk
medicine.medical_specialty
Population
030232 urology & nephrology
Urology
Renal function
030204 cardiovascular system & hematology
urologic and male genital diseases
Severity of Illness Index
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Severity of illness
medicine
Albuminuria
Humans
Cystatin C
Renal Insufficiency, Chronic
education
Aged
Transplantation
Creatinine
education.field_of_study
biology
business.industry
Reproducibility of Results
Middle Aged
medicine.disease
female genital diseases and pregnancy complications
chemistry
Nephrology
biology.protein
Disease Progression
Female
Cystatin
medicine.symptom
business
Kidney disease
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 14602385
- Volume :
- 34
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Accession number :
- edsair.doi.dedup.....0b277e9f320b11d19d98010cfb082d3a