title: Estimation of Glomerular Filtration Rate in Elderly Chronic Kidney Disease Patients: Comparison of Three Novel Sophisticated Equations and Simple Cystatin C Equation.
abstract: Estimating glomerular filtration rate (GFR) in elderly patients is a problem, since they are poorly represented in studies developing GFR equations. Serum cystatin C is a better indicator of GFR than serum creatinine in elderly patients. Therefore the aim of our study was to compare frequently used serum cystatin C based GFR equations with a gold standard (51CrEDTA clearance) in elderly chronic kidney disease (CKD) patients. 106 adult Caucasian patients, older than 65 years (58 women, 48 men; mean age 72.5 years), were included. In each patient51CrEDTA clearance, serum creatinine (IDMS traceable method) and serum cystatin C (immunonephelometric method) were determined. GFR was estimated using the Simple cystatin C, CKD-EPI cystatin C, CKD-EPI creatinine-cystatin C and BIS2 equation. Mean serum creatinine of our patients was 141.4 ± 41.5 μmol/L, mean serum cystatin C 1.79 ± 0.6 mg/L, mean51CrEDTA clearance was 52.2 ± 15.9 mL/min per 1.73 m2. Statistically significant correlations between51CrEDTA clearance and all formulas were found (P < 0.0001). In the receiver operating characteristic (ROC) curve analysis (cut-off for GFR 45 mL/min per 1.73 m2) no significant differences in diagnostic accuracy between all the before mentioned equations were found. Bland-Altman analysis for the same cut-off showed that CKD-EPI creatinine-cystatin C and BIS2 equation underestimated and CKD-EPI cystatin C and Simple cystatin C equation overestimated measured GFR. All equations lacked precision. Analysis of ability to correctly predict patient's GFR below or above 45 mL/min per 1.73 m2showed similar ability for all equations (P = 0.24-0.89). All equations are equally accurate for estimating GFR in elderly Caucasian CKD patients. For daily practice Simple cystatin C equation is most practical.
authors.affiliation: Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia.|Faculty of Medicine, University of Maribor, Maribor, Slovenia.
authors.forename: Sebastjan
authors.initials: S
authors.lastname: Bevc
authors.affiliation: Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia.
authors.forename: Nina
authors.initials: N
authors.lastname: Hojs
authors.affiliation: Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia.|Faculty of Medicine, University of Maribor, Maribor, Slovenia.
authors.forename: Radovan
authors.initials: R
authors.lastname: Hojs
authors.affiliation: Department of Dialysis, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia.|Faculty of Medicine, University of Maribor, Maribor, Slovenia.
authors.forename: Robert
authors.initials: R
authors.lastname: Ekart
authors.affiliation: Department of Nuclear Medicine, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia.
authors.forename: Maksimiljan
authors.initials: M
authors.lastname: Gorenjak
authors.affiliation: Department of Clinical Chemistry, University Clinical Centre Maribor, Maribor, Slovenia.|Faculty of Medicine, University of Maribor, Maribor, Slovenia.
authors.forename: Ludvik
authors.initials: L
authors.lastname: Puklavec
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology*; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D055316:Cystatin C
keywords: 51CrEDTA clearance; Chronic kidney disease-Elderly patients; Glomerular filtration rate-Estimation equations; Serum cystatin C