American Journal of Kidney Diseases

GFR Estimation Using Standardized Cystatin C in Kidney Transplant Recipients

Published:November 12, 2012DOI:


      The utility of serum cystatin C (SCysC) as a filtration marker in kidney transplantation is uncertain. We took advantage of the recent validation of a reference calibrator for SCysC and of newly developed CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations (2012) expressed for use with standardized SCysC level to reassess the performance of SCysC as a filtration marker in kidney transplant recipients.

      Study Design

      Study of diagnostic test accuracy.

      Setting & Participants

      670 kidney transplant recipients from 3 centers undergoing glomerular filtration rate (GFR) measurements from December 2006 to November 2012.

      Index Test

      Estimated GFR (eGFR) using the 2012 SCysC-based and serum creatinine (SCr)/SCysC-based CKD-EPI equations (eGFRcys and eGFRcr-cys, respectively) and the 2009 SCr-based CKD-EPI equation (eGFRcr), with SCysC and SCr measured at a single laboratory between April 2011 and June 2011.

      Reference Test

      Measured GFR (mGFR) using urinary clearance of inulin.


      Bias (the difference between mGFR and eGFR) was significantly smaller for eGFRcys and eGFRcr-cys versus eGFRcr (−2.82 and −0.54 vs +4.4 mL/min/1.73 m2, respectively; P < 0.001). Precision (standard deviation of the mean bias) also was better for eGFRcys and eGFRcr-cys versus eGFRcr (12 and 11 vs 13 mL/min/1.73 m2 [P < 0.001 for both comparisons]). Accuracy (percentage of GFR estimates within 30% of mGFR) was greater for eGFRcys and eGFRcr-cys versus eGFRcr (81% and 86% vs 75%, respectively [P = 0.004 and P < 0.001]). Net reclassification index with respect to mGFR of 30 mL/min/1.73 m2 for eGFRcr-cys and eGFRcys versus eGFRcr was 18.8% [95% CI, 8.6%-28.9%] and 22.5% [95% CI, 10.2%-34.9%].


      Patients were exclusively of European descent; association with transplant outcome was not evaluated.


      Our data validate the use of both the newly developed SCysC-based and SCr/SCysC-based CKD-EPI equations (2012) in kidney transplant recipients. Both equations perform better than the SCr-based CKD-EPI equation (2009).

      Index Words

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