Meta-Analysis
Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis,☆☆

https://doi.org/10.1053/ajkd.2002.34487Get rights and content

Abstract

Background: Serum cystatin C (Cys C) has been proposed as a simple, accurate, and rapid endogenous marker of glomerular filtration rate (GFR) in research and clinical practice. However, there are conflicting reports regarding the superiority of Cys C over serum creatinine (Cr), with a few studies suggesting no significant difference. Methods: We performed a meta-analysis of available data from various studies to compare the accuracy of Cys C and Cr in relation to a reference standard of GFR. A bibliographic search showed 46 articles until December 31, 2001. We also retrieved data from eight other studies presented and published in abstract form. Results: The overall correlation coefficient for the reciprocal of serum Cys C (r = 0.816; 95% confidence interval [CI], 0.804 to 0.826) was superior to that of the reciprocal of serum Cr (r = 0.742; 95% CI, 0.726 to 0.758; P < 0.001). Similarly, receiver operating characteristic (ROC)-plot area under the curve (AUC) values for 1/Cys C had greater identity with the reference test for GFR (mean ROC-plot AUC for Cys C, 0.926; 95% CI, 0.892 to 0.960) than ROC-plot AUC values for 1/Cr (mean ROC-plot AUC for serum Cr, 0.837; 95% CI, 0.796 to 0.878; P < 0.001). Immunonephelometric methods of Cys C assay produced significantly greater correlations than other assay methods (r = 0.846 versus r = 0.784; P < 0.001). Conclusion: In this meta-analysis using currently available data, serum Cys C is clearly superior to serum Cr as a marker of GFR measured by correlation or mean ROC-plot AUC. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Methods

A bibliographic search was performed for all published articles pertaining to the use of serum or plasma Cys C level as a marker of renal function or GFR. As of December 31, 2001, we identified 46 articles that compared the efficacy of Cys C with a standard method of GFR measurement, such as clearance of inulin or the tracers 51Cr-EDTA, 99Tm-DTPA, iothalamate, or iohexol. Review articles were included only if original and previously unpublished data were presented. In addition, we also included

Cys C has a greater correlation coefficient than Cr

There were 54 data sets incorporating 4,492 subject samples included in this meta-analysis. Of these, we first compared 36 data sets for Cys C correlation coefficients with 29 data sets for serum Cr. The range of correlation coefficients for both 1/Cys C and 1/Cr is shown in Fig 1A.

. (A) Scatter plot of correlation coefficients (r) for (■) 1/Cys C and (▴) 1/Cr from studies analyzed. Horizontal line represents the cumulative mean r of all studies. (B) Scatter plot of ROC-plot AUC values for

Discussion

The need for a simple, accurate, and minimally invasive marker of GFR has been a limiting factor in clinical nephrology research and practice. Although serum Cr is widely used as such a marker, its limitations are well known. More accurate methods, such as radiolabeled tracer clearances, are invasive, may involve radiation, and require several hours to perform. Many low-molecular-weight serum proteins were proposed as suitable endogenous markers of GFR, including β2-microglobulin and

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    Address reprint requests to Vikas R. Dharnidharka, MD, Assistant Professor, Division of Pediatric Nephrology, University of Florida Health Science Center, 1600 SW Archer Rd, PO Box 100296, Gainesville FL 32610-0296. E-mail: [email protected]

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