Glomerular filtration rate estimated by cystatin C among different clinical presentations

A. D. Rule, E. J. Bergstralh, J. M. Slezak, J. Bergert, T. S. Larson

Research output: Contribution to journalArticlepeer-review

313 Scopus citations


Glomerular filtration rate (GFR) estimates from serum creatinine has not been generalizable across all populations. Cystatin C has been proposed as an alternative marker for estimating GFR. The objective of this study was to compare cystatin C with serum creatinine for estimating GFR among different clinical presentations. Cystatin C and serum creatinine levels were obtained from adult patients (n=460) during an evaluation that included a GFR measurement by iothalamate clearance. Medical records were abstracted for clinical presentation (healthy, native chronic kidney disease or transplant recipient) at the time of GFR measurement. GFR was modeled using the following variables: cystatin C (or serum creatinine), age, gender and clinical presentation. The relationship between cystatin C and GFR differed across clinical presentations. At the same cystatin C level, GFR was 19% higher in transplant recipients than in patients with native kidney disease (P<0.001). The association between cystatin C and GFR was stronger among native kidney disease patients than in healthy persons (P<0.001 for statistical interaction). Thus, a cystatin C equation was derived using only patients with native kidney disease (n=204). The correlation with GFR (r2=0.853) was slightly higher than a serum creatinine equation using the same sample (r2=0.827), the Modification of Diet in Renal Disease equation (r2=0.825) or the Cockcroft-Gault equation (r2=0.796). Averaged estimates between cystatin C and serum creatinine equations further improved correlation (r 2=0.891). Cystatin C should not be interpreted as purely a marker of GFR. Other factors, possibly inflammation or immunosuppression therapy, affect cystatin C levels. While recognizing this limitation, cystatin C may improve GFR estimates in chronic kidney disease patients.

Original languageEnglish (US)
Pages (from-to)399-405
Number of pages7
JournalKidney international
Issue number2
StatePublished - Jan 2006


  • Glomerular filtration rate
  • Renal function measurement
  • Serum creatinine
  • Serum cystatin C

ASJC Scopus subject areas

  • Nephrology


Dive into the research topics of 'Glomerular filtration rate estimated by cystatin C among different clinical presentations'. Together they form a unique fingerprint.

Cite this