Abstract
Study design:
Prospective cohort study.
Objectives:
To investigate the relationship between 51chromium-ethylene-diamine-tetra-acetate (51Cr-EDTA) clearance, serum cystatin C (CysC), serum creatinine, creatinine clearance and estimated glomerular filtration rate (eGFRMDRD, MDRD stands for modification of diet in renal disease) based on the serum creatinine in patients with complete or incomplete spinal cord injury (SCI) and to develop and evaluate a GFR-estimating equation using serum CysC.
Settings:
Spinal Cord Injury Unit, Viborg Regional Hospital, Viborg, Denmark.
Methods:
Ninety-eight men and 47 women with SCI were included in the study. Serum CysC levels were measured by an automated particle-enhanced nephelometric immunoassay, serum and urine creatinine levels were measured by an enzymatic method traceable to the IDMS creatinine reference method, and 51Cr-EDTA clearance was measured by a multiple plasma sample method.
Results:
The area under the curves (AUCs) in the non-parametric receiver operating characteristics (ROC) plots for serum CysC were compared with serum creatinine and to eGFRMDRD and revealed a significant difference (P-value<0.05) for all SCI patients. There was no significant difference between the AUC for serum CysC compared with the AUC for creatinine clearance. GFR (ml min−1 per 1.73 m2) can be calculated from serum CysC values (mg l−1) using the equation eGFRCysC=212·exp(0.914·CysC). The model accurately predicted the GFR of 88% of patients within ±30% of the measured GFR, and it was able to predict the GFR of 50% of patients within ±10% of the measured GFR.
Conclusion:
In patients with SCI, GFR can be estimated independent of age, sex and muscle mass by a newly developed equation based on a single serum CysC value.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
MacDiarmid SA, McIntyre WJ, Anthony A, Bailey RR, Turner JG, Arnold EP . Monitoring of renal function in patients with spinal cord injury. BJU Int 2000; 85: 1014–1018.
Thomas L, Huber AR . Renal function--estimation of glomerular filtration rate. Clin Chem Lab Med 2006; 44: 1295–1302.
Perrone RD, Madias NE, Levey AS . Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem 1992; 38: 1933–1953.
Narayanan S, Appleton HD . Creatinine: a review. Clin Chem 1980; 26: 1119–1126.
Chikkalingaiah KB, Grant ND, Mangold TM, Cooke CR, Wall BM . Performance of simplified modification of diet in renal disease and Cockcroft-Gault equations in patients with chronic spinal cord injury and chronic kidney disease. Am J Med Sci 2010; 339: 108–116.
Sepahpanah F, Burns SP, McKnight B, Yang CC . Role of creatinine clearance as a screening test in persons with spinal cord injury. Arch Phys Med Rehabil 2006; 87: 524–528.
Soares AA, Eyff TF, Campani RB, Ritter L, Camargo JL, Silveiro SP . Glomerular filtration rate measurement and prediction equations. Clin Chem Lab Med 2009; 47: 1023–1032.
Levey AS, Coresh J, Greene T, Stevens LA, Zhang Y, Hendriksen S et al. Using Standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247–254.
Seronie-Vivien S, Delanaye P, Pieroni L, Mariat C, Froissart M, Cristol JP et al. Current position and future prospects. Clin Chem Lab Med 2008; 46: 1664–1686.
Randers E, Erlandsen EJ . Serum cystatin C as an endogenous marker of the renal function--a review. Clin Chem Lab Med 1999; 37: 389–395.
Erlandsen EJ, Randers E, Kristensen JH . Evaluation of the Dade Behring N Latex Cystatin C assay on the Dade Behring Nephelometer II System. Scand J Clin Lab Invest 1999; 59: 1–8.
Brochner-Mortensen J . Current status on assessment and measurement of glomerular filtration rate. Clin Physiol 1985; 5: 1–17.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39: S1–S266.
Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H . Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function. Clin Nephrol 2000; 54: 203–209.
Martensson A, Rustad P, Lund H, Ossowicki H . Creatininium reference intervals for corrected methods. Scand J Clin Lab Invest 2004; 64: 439–441.
Thomassen SA, Johannesen IL, Erlandsen EJ, Abrahamsen J, Randers E . Serum cystatin C as a marker of the renal function in patients with spinal cord injury. Spinal Cord 2002; 40: 524–528.
Lee JP, Dang AT . Evaluation of methods to estimate glomerular filtration rate versus actual drug clearance in patients with chronic spinal cord injury. Spinal Cord 2011; 49: 1158–1163.
Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008; 51: 395–406.
Tidman M, Sjostrom P, Jones I . A Comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant 2008; 23: 154–160.
Jenkins MA, Brown DJ, Ierino FL, Ratnaike SI . Cystatin C for estimation of glomerular filtration rate in patients with spinal cord injury. Ann Clin Biochem 2003; 40: 364–368.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest
Rights and permissions
About this article
Cite this article
Erlandsen, E., Hansen, R., Randers, E. et al. Estimating the glomerular filtration rate using serum cystatin C levels in patients with spinal cord injuries. Spinal Cord 50, 778–783 (2012). https://doi.org/10.1038/sc.2012.52
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2012.52
Keywords
This article is cited by
-
Urologic surveillance of persons with spinal cord injuries – a scoping review
Spinal Cord (2024)
-
Assessment of renal function in persons with motor complete spinal cord injury—cystatin C as an accurate single marker
Spinal Cord (2024)
-
Endocrinological and inflammatory markers in individuals with spinal cord injury: A systematic review and meta-analysis
Reviews in Endocrine and Metabolic Disorders (2022)
-
Serum cystatin C is increased in acute spinal cord injury: a multicentre retrospective study
Spinal Cord (2020)
-
Evaluating estimated glomerular filtration rates of creatinine and cystatin C for male patients with chronic spinal cord injury
Spinal Cord (2018)
