TY - JOUR
T1 - Prediction of the Renal Elimination of Drugs With Cystatin C vs Creatinine
T2 - A Systematic Review
AU - Barreto, Erin F.
AU - Rule, Andrew D.
AU - Murad, M. Hassan
AU - Kashani, Kianoush B.
AU - Lieske, John C.
AU - Erwin, Patricia J.
AU - Steckelberg, James M.
AU - Gajic, Ognjen
AU - Reid, Joel M.
AU - Kane-Gill, Sandra L.
N1 - Publisher Copyright:
© 2018 Mayo Foundation for Medical Education and Research
PY - 2019/3
Y1 - 2019/3
N2 - 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.
AB - 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.
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U2 - 10.1016/j.mayocp.2018.08.002
DO - 10.1016/j.mayocp.2018.08.002
M3 - Review article
C2 - 30713050
AN - SCOPUS:85060757081
SN - 0025-6196
VL - 94
SP - 500
EP - 514
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 3
ER -