Prediction of the Renal Elimination of Drugs With Cystatin C vs Creatinine: A Systematic Review

Erin F. Barreto, Andrew D. Rule, M. Hassan Murad, Kianoush B. Kashani, John C. Lieske, Patricia J. Erwin, James M. Steckelberg, Ognjen Gajic, Joel M. Reid, Sandra L. Kane-Gill

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


Serum cystatin C has been proposed as a kidney biomarker to inform drug dosing. We conducted a systematic review to synthesize available data for the association between serum cystatin C and drug pharmacokinetics, dosing, and clinical outcomes in adults (≥18 years). PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Scopus were systematically searched from 1946 to September 2017 to identify candidate studies. Studies of cystatin C as a predictor for acute kidney injury or for management of contrast-associated acute kidney injury were excluded. Also, studies were excluded if drug concentrations were unavailable and if a reference standard for drug dosing (eg, serum creatinine) was not concurrently reported. The outcomes of interest included drug clearance (L/h), concentrations (mg/L), target level achievement (%), therapeutic failure (%), and drug toxicity (%). We included 28 articles that evaluated 16 different medications in 3455 participants. Vancomycin was the most well-studied drug. Overall, cystatin C–based estimated glomerular filtration rate (eGFR Cystatin C ) was more predictive of drug levels and drug clearance than eGFR Creatinine . In only one study were target attainment and outcomes compared between 2 drug-dosing regimens, one based on eGFR Creatinine-Cystatin C and one dosed with the Cockcroft-Gault creatinine clearance equation. Compared with eGFR Creatinine , use of eGFR Cystatin C to predict elimination of medications via the kidney was as accurate, if not superior, in most studies, but infrequently were data on target attainment or clinical outcomes reported. Drug-specific dosing protocols that use cystatin C to estimate kidney function should be tested for clinical application.

Original languageEnglish (US)
Pages (from-to)500-514
Number of pages15
JournalMayo Clinic proceedings
Issue number3
StatePublished - Mar 2019

ASJC Scopus subject areas

  • Medicine(all)


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