title: Systematic shifts in cystatin C between 2006 and 2010.
abstract: OBJECTIVE
  Cystatin C is used increasingly as a biomarker of renal function; however, cystatin C assays are not standardized. Our objective was to compare cystatin C results within the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study over time and in repeated measures to evaluate for assay drift.
  
  
  METHODS
  Serum samples were obtained at baseline (visit 1 [V1], 2000 to 2002) and follow-up (visit 2 [V2], 2003 to 2005; visit 3 [V3], 2006 to 2008) and were assayed in 2006 (V1), 2007 to 2008 (V2), and 2010 (V3) in the same laboratory.
  
  
  RESULTS
  Mean cystatin C levels measured using the Dade-Behring assay decreased over time in subjects, with measures at all three visits (V1: 0.80 ± 0.19 [0.42 to 3.41], V2: 0.75 ± 0.22 [0.39 to 3.77], and V3: 0.69 ± 0.22 [0.39 to 3.79]). Cystatin C values were lower in V1 and V2 samples remeasured in 2010 (mean differences -0.13 ± 0.04 and -0.08 ± 0.04, P < 0.0001 for both). Correlations for original and re-run values were strong for V1 (r = 0.99) and V2 (r = 0.99). Deming regression equations and Bland-Altman plots suggest a systematic shift in the values over time.
  
  
  CONCLUSIONS
  Systematic shifts in cystatin C levels, which can be corrected by regression adjustment, occurred in our laboratory in samples measured in 2006 and 2007 to 2008 as compared with 2010. Assay standardization and measurement reliability for cystatin C must be addressed.
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado-Denver, PO Box 6511, Mail Stop A140, Aurora, CO 80045, USA. David.Maahs@uchsc.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.forename: Diana
authors.initials: D
authors.lastname: Jalal
authors.forename: Kim
authors.initials: K
authors.lastname: McFann
authors.forename: Marian
authors.initials: M
authors.lastname: Rewers
authors.forename: Janet K
authors.initials: JK
authors.lastname: Snell-Bergeon
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003120:Colorado; D055316:Cystatin C / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D003928:Diabetic Nephropathies / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D018450:Disease Progression; D006801:Humans; D007677:Kidney Function Tests / Q000592:standards; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C