title: KDIGO Guidelines and Kidney Transplantation: Is the Cystatin-C Based Recommendation Relevant?
abstract: The KDIGO guidelines propose a new approach to diagnose chronic kidney disease (CKD) based on estimated glomerular filtration rate (GFR). In patients with a GFR value comprised between 45 and 59 mL/min/1.73 m(2) as estimated by the CKD-EPI creatinine equation (eGFRcreat ), it is suggested to confirm the diagnosis with a second estimation using the CKD-EPI cystatin C-based equations (eGFRcys /eGFRcreat-cys) . We sought to determine whether this new diagnostic strategy might extend to kidney transplant recipients (KTR) and help to identify those with decreased GFR. In 670 KTR for whom a measured GFR was available, we simulated the detection of CKD using the two-steps approach recommended by the guidelines in comparison to the conventional approach relying on creatinine equation. One hundred forty-five patients with no albuminuria had eGFRcreat between 45 and 59 mL/min/1.73 m(2) . Among them, 23% had inulin clearance over 60 mL/min/1.73 m(2) and were thus incorrectly classified as CKD patients. When applying the Kidney Disease: Improving Global Outcomes (KDIGO) strategy, 138 patients were confirmed as having a GFR below 60 mL/min with eGFRcreat-cys . However, 21% of them were misclassified in reference to measured GFR. Our data do no not support the use of cystatin C as a confirmatory test of stage 3 A CKD in KTR.
authors: Renal Laboratory and Department of Nephrology-Dialysis-Transplantation, University Jean Monnet, CHU Hôpital Nord, Saint-Etienne, France.
authors: I
authors: I
authors: Masson
authors: Renal Laboratory and Department of Nephrology-Dialysis-Transplantation, University Jean Monnet, CHU Hôpital Nord, Saint-Etienne, France.
authors: N
authors: N
authors: Maillard
authors: Department of Clinical Chemistry, University of Li, e, ge, CHU Sart Tilman, Liège, Belgium.
authors: E
authors: E
authors: Cavalier
authors: Renal Laboratory and Department of Nephrology-Dialysis-Transplantation, University Jean Monnet, CHU Hôpital Nord, Saint-Etienne, France.
authors: E
authors: E
authors: Alamartine
authors: Renal Laboratory and Department of Nephrology-Dialysis-Transplantation, University Jean Monnet, CHU Hôpital Nord, Saint-Etienne, France.
authors: C
authors: C
authors: Mariat
authors: Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
authors: P
authors: P
authors: Delanaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D055316:Cystatin C
keywords: clinical decision-making; clinical research / practice; glomerular filtration rate (GFR); kidney transplantation / nephrology