Cystatin C should be routinely available for estimating kidney function

Lees, J. S. , Fabian, J. and Shlipak, M. G. (2024) Cystatin C should be routinely available for estimating kidney function. Current Opinion in Nephrology and Hypertension, 33(3), pp. 337-343. (doi: 10.1097/MNH.0000000000000980) (PMID:38411195)

Abstract

Purpose of review: In this report, we summarize why the availability of cystatin C is important across a variety of clinical scenarios, the recent literature on when, why and in whom cystatin C testing should be considered, and how nephrologists can take practical steps to incorporate cystatin C testing into their practice. Recent findings: Large intra-individual discrepancies between eGFRcr and eGFRcys (known as eGFRdiff) are observed in at least 1 in 4 people. These differences are seen more commonly among more vulnerable individuals: older adults, females, non-White individuals and those living with multiple medical conditions. A large eGFRdiff, where eGFRcys is lower than eGFRcr, is associated with a plethora of adverse outcomes, including medication-associated adverse events, acute kidney injury, cardiovascular disease, kidney failure and all-cause mortality. Among studies that have measured GFR, eGFRcr-cys usually provides the most accurate estimation of kidney function compared to mGFR, including among participants with large discrepancies between eGFRcr and eGFRcys. Summary: Cystatin C improves sensitivity and specificity of CKD diagnosis, improves detection of harmful acute and chronic changes in kidney function, improves precision of treatment eligibility and safety, and may reduce healthcare inequalities. Better education, curiosity, and motivation among nephrologists could substantially improve the availability and utilization of cystatin C.

• Item Type: Articles
• Additional Information: Funding sources: J.S.L. is personally funded by a Wellcome Trust Early Career Award (301005/Z/23/Z).
• Keywords: Cystatin C, creatinine, eGFR, chronic kidney disease.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lees, Jennifer
• Authors: Lees, J. S., Fabian, J., and Shlipak, M. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Current Opinion in Nephrology and Hypertension
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 1062-4821
• Published Online: 23 February 2024