Abstract
BackgroundAccurate assessment of GFR is critical in patients with chronic liver disease for early detection of renal disease. Cystatin C is a marker of GFR that seems to be more accurate than creatinine. The aim of the study is to assess of the performance of creatinine and cystatin C-based GFR equations in Egyptian patients with hepatitis C virus (HCV)-related liver cirrhosis as compared to measured creatinine clearance. GFR was estimated using five equations; three that were based on serum creatinine, another that was based on serum cystatin C, and a third that was based on both in 120 patients with HCV-related liver cirrhosis as well as 60 age- and sex-matched healthy controls. The bias, precision, and accuracy of each equation were determined as compared to measured creatinine clearance using the traditional equation U*V/P.ResultsThe mean measured creatinine clearance was 51.39 ± 16.05 ml/min per 1.73 m2. The CKD-EPI creatinine-cystatin C equation had the greatest precision (7.5 ml/min per 1.73 m2), and highest accuracy (68 and 93% within 10% and 30% of measured GFR, respectively), but not the lowest bias (5.4 ml/min per 1.73 m2). The CKD-EPI creatinine-cystatin C equation remained accurate even in both males (69 and 90% within 10% and 30% of measured GFR, respectively) and females (68 and 97% within 10% and 30% of measured GFR, respectively). The CKD-EPI creatinine-cystatin C equation remained accurate even when the measured GFR was ≥ 60 ml/min per 1.73 m2 (60 and 90% within 10% and 30% of measured GFR, respectively with precision 10.5 ml/min per 1.73 m2).ConclusionCKD-EPI creatinine-cystatin C equation is more accurate at predicting GFR in HCV-related liver cirrhosis than creatinine- and cystatin-C alone based equations.
Highlights
Accurate assessment of glomerular filtration rate (GFR) is critical in patients with chronic liver disease for early detection of renal disease
This study was an observational hospital-based, cohort study to compare the accuracy of different glomerular filtration rate equations based on creatinine, cystatin C, and both as valuable tools in the detection of kidney disease in liver cirrhosis related to hepatitis C virus (HCV) in Egyptian patients; with the participants being recruited from the Internal Medicine Department of Minia University hospital
Our cross-sectional observational study has demonstrated that eGFR using Chronic kidney disease–epidemiology collaboration (CKD-EPI) creatinine-cystatin C equation provide results comparable to those measured by creatinine clearance with the best performance; creatinine and cystatin Cbased equations were inaccurate for the assessment of renal function in cirrhotic patients
Summary
Accurate assessment of GFR is critical in patients with chronic liver disease for early detection of renal disease. The aim of the study is to assess of the performance of creatinine and cystatin C-based GFR equations in Egyptian patients with hepatitis C virus (HCV)-related liver cirrhosis as compared to measured creatinine clearance. GFR was estimated using five equations; three that were based on serum creatinine, another that was based on serum cystatin C, and a third that was based on both in 120 patients with HCV-related liver cirrhosis as well as 60 age- and sex-matched healthy controls. The CKD-EPI creatinine-cystatin C equation remained accurate even when the measured GFR was ≥ 60 ml/min per 1.73 m2 (60 and 90% within 10% and 30% of measured GFR, respectively with precision 10.5 ml/min per 1.73 m2). Measured GFR (mGFR) is recommended as a confirmatory test when more accuracy is needed [4]
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