Estimated Glomerular Filtration Rate Using Cystatin C is a More Sensitive Marker for Kidney Dysfunction in Nonweight-bearing Individuals

No AccessJournal of UrologyAdult Urology1 Feb 2023Estimated Glomerular Filtration Rate Using Cystatin C is a More Sensitive Marker for Kidney Dysfunction in Nonweight-bearing Individuals Glenn T. Werneburg, Daniel Hettel, Stacy Jeong, Gregory Nemunaitis, Jonathan J. Taliercio, and Hadley M. Wood Glenn T. WerneburgGlenn T. Werneburg *Correspondence: Department of Urology, Glickman Urological & Kidney Institute, Cleveland, OH 44195 telephone: 216-444-2200; E-mail Address: [email protected] https://orcid.org/0000-0002-9518-672X Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio , Daniel HettelDaniel Hettel Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio , Stacy JeongStacy Jeong Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio , Gregory NemunaitisGregory Nemunaitis Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio , Jonathan J. TaliercioJonathan J. Taliercio Department of Kidney Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio , and Hadley M. WoodHadley M. Wood Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio View All Author Informationhttps://doi.org/10.1097/JU.0000000000003070AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Individuals with neuromuscular disorders and neurogenic lower urinary tract dysfunction are commonly nonweight-bearing with lower lean muscle mass than the general population. We sought to compare estimated glomerular filtration rate equations that include creatinine, cystatin C, or both, in nonweight-bearing individuals and matched ambulatory controls. Materials and Methods: Records were reviewed for individuals with serum creatinine (Cr) and cystatin C (Cys) and diagnosis consistent with nonweight-bearing status, and matched ambulatory controls. The 2021 CKD-EPI (Chronic Kidney Disease-Epidemiology Collaboration) race agnostic equations were used to calculate estimated glomerular filtration rate. Renal function was compared by equation in the overall cohorts and in a patient subset with imaging and/or urinalysis evidence of renal dysfunction. Results: Nonweight-bearing (n = 102) and control populations (n = 204) had similar demographics. In the nonweight-bearing population, estimated glomerular filtration rate differed when calculated using CKD-EPICr, CKD-EPICr+Cys, and CKD-EPICys (107, 93, 80 mL/min/1.73 m2, respectively, P < .001). The differences in estimated glomerular filtration rate were greater in the nonweight-bearing relative to the control group regardless of CKD-EPI equation pairs compared (P < .001). In the patient subset with imaging and/or proteinuria evidence of renal dysfunction, the nonweight-bearing population again had different estimated glomerular filtration rate when calculated using CKD-EPICr, CKD-EPICr+Cys, and CKD-EPICys (P < .001). Fifty-eight percent of nonweight-bearing individuals with evidence of renal dysfunction on imaging or urinalysis were reclassified into a lower estimated glomerular filtration rate category when using estimated glomerular filtration rateCys relative to estimated glomerular filtration rateCr. Conclusions: Estimated glomerular filtration rate equations containing serum creatinine, cystatin C, or both, validated in mostly ambulatory populations, are not equivalently accurate in estimating kidney function in nonweight-bearing individuals. Comparison of these equations against gold standard glomerular filtration rate measurement is needed to determine which most closely approximates true glomerular filtration rate. References 1. . 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Ethics Statement: This study received Institutional Review Board approval (IRB No. 22-218). © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 2February 2023Page: 391-398Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordsurinary bladder, neurogenicspinal cord injuriescystatin Cglomerular filtration ratecreatinineMetricsAuthor Information Glenn T. Werneburg Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio *Correspondence: Department of Urology, Glickman Urological & Kidney Institute, Cleveland, OH 44195 telephone: 216-444-2200; E-mail Address: [email protected] More articles by this author Daniel Hettel Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Stacy Jeong Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Gregory Nemunaitis Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Jonathan J. Taliercio Department of Kidney Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Hadley M. Wood Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Expand All Submitted June 18, 2022; accepted November 7, 2022; published November 16, 2022. Support: HMW receives research support from Boston Scientific. Conflict of Interest: Research support: HMW. Ethics Statement: This study received Institutional Review Board approval (IRB No. 22-218). Advertisement PDF downloadLoading ...