Mary Kathryn Bohn, Meshach Asare-Werehene, Felix Leung, Davor Brinc, Rajeevan Selvaratnam
{"title":"基于肌酐和胱抑素 C 的实体器官移植患者肾小球滤过率(eGFR)估算结果不一致。","authors":"Mary Kathryn Bohn, Meshach Asare-Werehene, Felix Leung, Davor Brinc, Rajeevan Selvaratnam","doi":"10.1016/j.clinbiochem.2024.110853","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Estimation of glomerular filtration rate is a critical component of assessing kidney function post-solid organ transplantation and in monitoring risk of acute injury. Our objective was to evaluate estimated glomerular filtration rate (eGFR) as derived from creatinine (eGFR<sub>cr</sub>), cystatin C (eGFR<sub>cys</sub>), and both (eGFR<sub>cr-cys</sub>) in a cohort of transplant recipients.</p><p><strong>Methods: </strong>A total of 47 unique post-solid organ transplant patients receiving tacrolimus were included. Residual specimens were assayed for creatinine (Jaffe and enzymatic), cystatin C, and tacrolimus. eGFR was estimated using the 2021 chronic kidney disease (CKD)-EPI formulae. Results were compared by Deming regression and bias was assessed using non-parametric cumulative distribution plots. Percent agreement in chronic kidney disease (CKD) by stage was evaluated across equations.</p><p><strong>Results: </strong>eGFR<sub>cr</sub> relative to eGFR<sub>cys</sub> estimates demonstrated a median bias of -22 mL/min/1.73 m<sup>2</sup> and an overall 21.3 % [95 % CI: 12.1, 35.0] agreement in CKD staging. eGFR<sub>cr-cys</sub> demonstrated a median bias of -14 mL/min/1.73 m<sup>2</sup> and overall agreement of 34.0 % [95 % CI: 22.3, 48.4] relative to eGFR<sub>cr</sub> (enzymatic). Discordance increased proportionally with eGFR and did not differ by creatinine assay (Jaffe or enzymatic).</p><p><strong>Conclusion: </strong>Cystatin C incorporation leads to markedly negative biases between eGFR estimates in patients with solid organ transplant, implying lack of applicability in the transplant setting. This highlights the dependency of patient characteristics on equation performance and the need to consider confounding factors in interpretation and utilization of cystatin C based equations.</p>","PeriodicalId":10172,"journal":{"name":"Clinical biochemistry","volume":" ","pages":"110853"},"PeriodicalIF":2.5000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discordance between creatinine and cystatin C-based estimation of glomerular filtration rate (eGFR) in solid organ transplant patients.\",\"authors\":\"Mary Kathryn Bohn, Meshach Asare-Werehene, Felix Leung, Davor Brinc, Rajeevan Selvaratnam\",\"doi\":\"10.1016/j.clinbiochem.2024.110853\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Estimation of glomerular filtration rate is a critical component of assessing kidney function post-solid organ transplantation and in monitoring risk of acute injury. Our objective was to evaluate estimated glomerular filtration rate (eGFR) as derived from creatinine (eGFR<sub>cr</sub>), cystatin C (eGFR<sub>cys</sub>), and both (eGFR<sub>cr-cys</sub>) in a cohort of transplant recipients.</p><p><strong>Methods: </strong>A total of 47 unique post-solid organ transplant patients receiving tacrolimus were included. Residual specimens were assayed for creatinine (Jaffe and enzymatic), cystatin C, and tacrolimus. eGFR was estimated using the 2021 chronic kidney disease (CKD)-EPI formulae. Results were compared by Deming regression and bias was assessed using non-parametric cumulative distribution plots. Percent agreement in chronic kidney disease (CKD) by stage was evaluated across equations.</p><p><strong>Results: </strong>eGFR<sub>cr</sub> relative to eGFR<sub>cys</sub> estimates demonstrated a median bias of -22 mL/min/1.73 m<sup>2</sup> and an overall 21.3 % [95 % CI: 12.1, 35.0] agreement in CKD staging. eGFR<sub>cr-cys</sub> demonstrated a median bias of -14 mL/min/1.73 m<sup>2</sup> and overall agreement of 34.0 % [95 % CI: 22.3, 48.4] relative to eGFR<sub>cr</sub> (enzymatic). Discordance increased proportionally with eGFR and did not differ by creatinine assay (Jaffe or enzymatic).</p><p><strong>Conclusion: </strong>Cystatin C incorporation leads to markedly negative biases between eGFR estimates in patients with solid organ transplant, implying lack of applicability in the transplant setting. This highlights the dependency of patient characteristics on equation performance and the need to consider confounding factors in interpretation and utilization of cystatin C based equations.</p>\",\"PeriodicalId\":10172,\"journal\":{\"name\":\"Clinical biochemistry\",\"volume\":\" \",\"pages\":\"110853\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-11-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical biochemistry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.clinbiochem.2024.110853\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICAL LABORATORY TECHNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical biochemistry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clinbiochem.2024.110853","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}
Discordance between creatinine and cystatin C-based estimation of glomerular filtration rate (eGFR) in solid organ transplant patients.
Background: Estimation of glomerular filtration rate is a critical component of assessing kidney function post-solid organ transplantation and in monitoring risk of acute injury. Our objective was to evaluate estimated glomerular filtration rate (eGFR) as derived from creatinine (eGFRcr), cystatin C (eGFRcys), and both (eGFRcr-cys) in a cohort of transplant recipients.
Methods: A total of 47 unique post-solid organ transplant patients receiving tacrolimus were included. Residual specimens were assayed for creatinine (Jaffe and enzymatic), cystatin C, and tacrolimus. eGFR was estimated using the 2021 chronic kidney disease (CKD)-EPI formulae. Results were compared by Deming regression and bias was assessed using non-parametric cumulative distribution plots. Percent agreement in chronic kidney disease (CKD) by stage was evaluated across equations.
Results: eGFRcr relative to eGFRcys estimates demonstrated a median bias of -22 mL/min/1.73 m2 and an overall 21.3 % [95 % CI: 12.1, 35.0] agreement in CKD staging. eGFRcr-cys demonstrated a median bias of -14 mL/min/1.73 m2 and overall agreement of 34.0 % [95 % CI: 22.3, 48.4] relative to eGFRcr (enzymatic). Discordance increased proportionally with eGFR and did not differ by creatinine assay (Jaffe or enzymatic).
Conclusion: Cystatin C incorporation leads to markedly negative biases between eGFR estimates in patients with solid organ transplant, implying lack of applicability in the transplant setting. This highlights the dependency of patient characteristics on equation performance and the need to consider confounding factors in interpretation and utilization of cystatin C based equations.
期刊介绍:
Clinical Biochemistry publishes articles relating to clinical chemistry, molecular biology and genetics, therapeutic drug monitoring and toxicology, laboratory immunology and laboratory medicine in general, with the focus on analytical and clinical investigation of laboratory tests in humans used for diagnosis, prognosis, treatment and therapy, and monitoring of disease.