Assessment of estimated glomerular filtration rate based on cystatin C in diabetic nephropathy

Akpınar, Kadriye; Aslan, Diler; Fenkçi, Semin Melahat

doi:10.1590/2175-8239-JBN-2020-0145

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Brazilian Journal of Nephrology

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Original Article • Braz. J. Nephrol. 43 (3) • Jul-Sep 2021 • https://doi.org/10.1590/2175-8239-JBN-2020-0145 copy

Assessment of estimated glomerular filtration rate based on cystatin C in diabetic nephropathy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

GFR is estimated by using creatinine and cystatin C to determine renal dysfunction. Our aim was to evaluate estimated GFR (eGFR) based on cystatin C in type 2 diabetic patients with diabetic nephropathy (DN).

Methods:

Study group included 52 controls (46% male, age: 54.5±12.4) and 101 diabetic patients (46.5% male, age: 58.2±11). The diabetics were divided into three subgroups according to 24-hour urine albumin: normal to mildly increased (A1) (n=51), moderately increased (A2) (n=25), severely increased (A3) (n=25) albuminuria. Creatinine clearance (CrCl) was determined. Correlations between CrCl and eGFRs estimated according to the CKD-EPI, MDRD, and Cockcroft-Gault (CG) formulas, and ROC curves were evaluated. Data were analyzed using SPSS 22.0.

Results:

Only CKD-EPI-cys eGFR was significantly lower in the A1 group than the controls (p=0.021). All GFRs were lower in the A3 group than the control (CKD-EPI-cr, MDRD, CKD-EPI-cys, CKD-EPI-cr-cys: p=0.0001, CG and CrCl: p=0.001) and A1 (for all GFRs p=0.0001) groups. CKD-EPI-cr (p=0.004), MDRD (p=0.01), CG (p=0.037), CKD-EPI-cys (p=0.033), and CKD-EPI-cr-cys (p=0.016) eGFRs in the A2 group were significantly different from the A1 group. All eGFRs showed a moderate correlation with CrCl in the A1group (CKD-EPI-cr and CKD-EPI-cr-cys: r=0.49, p=0.0001, MDRD: r=0.44, p=0.001, CG r=0.48, p=0.0001: CKD-EPI-cys r=0.40, p=0.004). The area under the CKD-EPI-cys ROC curve was the highest and found to be 0.847 (95%CI 0.763-0.931, p=0.0001).

Conclusions:

Our results showed that the CKD-EPI-cys eGFR can be useful in detecting the early stage of DN and more predictive than the others for prediction of DN.

Keywords:
Diabetes Mellitus, Type 2; Diabetic Nephropathies; Glomerular Filtration Rate; Cystatin C

	Control (n=52)	A1 (n=51)	A2 (n=25)	A3 (n=25)	P value
Age (years)	54 (12)	57 (10)	61 (12)	56 (11)	0.114
Male (n, %)	24, 46	18, 35	12, 48	17, 68	0.064
Race-White (%)	100	100	100	100
Body Weight (kg)	75 (64-84)	80 (72-89)	82 (70-92)	82 (70-98)	0.051
BMI (kg/m²)	25 (23-27)	31 (28-34)	31 (28-35)	29 (26-33)	0.0001
BSA (m²)^ BSA (body surface area) was calculated using the DuBois formula.	1.85 (0.18)	1.83 (0.17)	1.88 (0.19)	1.92 (0.20)	0.25
SBP (mmHg)	120 (110-120)	125 (120-140)	130 (120-142)	130 (120-150)	0.0001
DBP (mmHg)	80 (70-80)	75 (65-80)	80 (70-80)	75 (70-80)	0.621
Current Smoker (n, %)	0, 0	5, 9	4, 16	3, 12	0.055
Alcohol Use (n, %)	0, 0	4, 8	2, 8	3, 12	0.139
Duration of DM (years)	0	10 (5-15)	20 (7-20)	12 (7-19)	0.0001
Duration of DN (years)	0	0	2 (1-6)	4 (1.5-8)	0.178
Hct (%)	42(4)	40 (4)	40 (4)	40 (7)	0.247
HbA1c (mmol/mol)^* ******* The relationship of HbA1c with the NGSP (%HbA1c) and the IFCC (mmol/mol) is: NGSP = [0.09148 * IFCC] + 2.152.**	38 (36-40.7)	61 (50-74)	58 (50-84)	68 (52-98.5)	0.0001
sTP (g/L)	72 (3)	73 (4)	70 (5)	67 (7)	0.0001
sAlb (g/L)	46 (2)	45 (3)	43 (3)	40 (5)	0.0001
sUrea (mmol/L)	9 (7.5-11)	9.6 (8.2-12.8)	12.8 (8.9-16.2)	21.8 (12.5-31)	0.0001
sCr (µmol/L)	70 (58-80)	65 (56-77)	88 (71-119.5)	140 (94.5-204.5)	0.0001
sCys C (mg/L)	0.86 (0.79-0.95)	0.98 (0.86-1.16)	1.42 (1-1.84)	2.12 (1.47-3.43)	0.0001
uTP (mg/24 h)	192 (144-269)	123 (80-171)	185 (143-272)	1606 (853-2017)	0.0001
uAlb (mg/24 h)	4 (3-6)	5 (3-9)	77 (46-162)	1031 (530-1696)	0.0001
uCr (mg/24 h)	989 (710-1167)	1018 (844-1246)	893 (741-1302)	1047 (768-1351)	0.703
CrCl (mL/min/1.73 m²)	79 (58-107)	90 (72-105)	53 (43-92)	37 (18-75)	0.0001
CKD-EPI-cr (mL/min/1.73 m²)	93 (87-101)	97 (84-103)	71 (47-90)	44 (24-78)	0.0001
MDRD (mL/min/1.73 m²)	88 (78-99)	90 (78-101)	70 (47-85)	44 (24-71.6)	0.0001
CG (mL/min/1.73 m²)	84 (72-96)	90 (80-108)	64 (44-102)	48 (25-75)	0.0001
CKD-EPI-cys (mL/min/1.73 m²)	92 (82-101)	77 (61-89)	48 (33-76)	27 (14-27)	0.0001
CKD-EPI-cr-cys (mL/min/1.73 m²)	85 (93-104)	86 (70-100)	57 (38-79.5)	34 (20.5-56)	0.0001

P Values	CrCl	CKD-EPI-cr	MDRD	CG	CKD-EPI-cys	CKD-EPI-cr-cys
Control-A1	1.000	1.000	1.000	1.000	0.021^* * p<0.05.	0.243
Control-A2	0.265	0.007^* * p<0.05.	0.012^* * p<0.05.	0.367	0.0001^* * p<0.05.	0.0001^* * p<0.05.
Control-A3	0.001^* * p<0.05.	0.0001^* * p<0.05.	0.0001^* * p<0.05.	0.001^* * p<0.05.	0.0001^* * p<0.05.	0.0001^* * p<0.05.
A1-A2	0.026^* * p<0.05.	0.004^* * p<0.05.	0.010^* * p<0.05.	0.037^* * p<0.05.	0.033^* * p<0.05.	0.016^* * p<0.05.
A1-A3	0.0001^* * p<0.05.	0.0001^* * p<0.05.	0.0001^* * p<0.05.	0.0001^* * p<0.05.	0.0001^* * p<0.05.	0.0001^* * p<0.05.
A2-A3	0.672	0.327	0.196	0.544	0.131	0.145

	CKD-EPI-cr		MDRD		CG		CKD-EPI-cys		CKD-EPI-cr-cys
CrCl	r	p	r	p	r	p	r	p	r	p
Control	0.32	0.02^* * p<0.05.	0.44	0.001^* * p<0.05.	0.01	0.935	0.12	0.377	0.30	0.032^* * p<0.05.
A1	0.49	0.0001^* * p<0.05.	0.44	0.001^* * p<0.05.	0.48	0.0001^* * p<0.05.	0.40	0.004^* * p<0.05.	0.49	0.0001^* * p<0.05.
A2	0.84	0.0001^* * p<0.05.	0.83	0.0001^* * p<0.05.	0.84	0.0001^* * p<0.05.	0.70	0.0001^* * p<0.05.	0.82	0.0001^* * p<0.05.
A3	0.93	0.0001^* * p<0.05.	0.93	0.0001^* * p<0.05.	0.85	0.0001^* * p<0.05.	0.90	0.0001^* * p<0.05.	0.94	0.0001^* * p<0.05.

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[1] Correspondence to: Kadriye Akpınar. E-mail: dr.akpinar.kadriye@gmail.com