Is cystatin C a better marker than creatinine for evaluating residual renal function in patients on continuous ambulatory peritoneal dialysis?
Is cystatin C a better marker than creatinine for evaluating residual renal function in patients on continuous ambulatory peritoneal dialysis?
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DOI：
10.1093/ndt/gfr045
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发表时间：
2011-10
期刊：
影响因子：
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通讯作者：
Qiongqiong Yang;Ruixi Li;Z. Zhong;H. Mao;Jin-jin Fan;Jianxiong Lin;X. Yang;Xueqin Wang;Zhibin Li;Xueqing Yu
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文献类型：
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作者：
Qiongqiong Yang;Ruixi Li;Z. Zhong;H. Mao;Jin-jin Fan;Jianxiong Lin;X. Yang;Xueqin Wang;Zhibin Li;Xueqing Yu
背景
目前对连续不卧床腹膜透析（CAPD）患者残余肾功能（RRF）的临床评估通常需要24小时的尿液收集，这有时对患者来说很困难并且会导致随机误差。客观的。我们的研究旨在调查 CAPD 中血清胱抑素 C (CysC) 是否可以作为比血清肌酐 (Cr) 更好的 RRF 标志物，并开发一个用 CysC 水平评估 RRF 的公式。
方法
来自单个透析单位的 160 名 CAPD 患者被随机分为建模组 (n(1) = 120) 和验证组 (n(2) = 40)。 RRF 被评估为尿素和肌酐的肾脏清除率的平均值。然后，我们根据模型组的 CysC 和 Cr 水平推导出 RRF 公式，并通过与已发表的基于 CysC 的方程和肾病饮食修改公式进行比较来验证它们。
结果
CysC 水平与 RRF、Kt/V（尿素）和每周总 Ccr 呈负相关，但与年龄、性别、体重指数、糖尿病或腹膜清除率无关。由CysC和Cr导出的RRF公式分别为(sinh(ln(6.736-0.566 CysC)))(2)和(sinh(ln(6.097-0.265 Cr)))(2)。当应用于验证组时，基于 CysC 的估计 RRF (2.8 ± 1.2 mL/min/1.73 m(2)) 与基于 Cr 的估计 RRF (2.8 ± 1.3 mL/min/1.73 m(2)) 和测量的 RRF (2.9 ± 1.7 mL/min/1.73 m(2)) 相似。与 Cr 公式和其他公式相比，CysC 公式显示出较小的偏差，具有最佳的 30% 和 50% 准确度，并且具有更大的曲线下面积以及更高的灵敏度和特异性。
结论
血清 CysC 可能是评估 CAPD 患者 RRF 的良好标志物。推导的 CysC 公式可用于可靠地估计 CAPD 患者的 RRF，而无需收集 24 小时尿液。
BACKGROUND
Current clinical assessments of residual renal function (RRF) for continuous ambulatory peritoneal dialysis (CAPD) patients usually require 24 h of urine collection, which is sometimes difficult for patients and contributes to random errors. Objective. Our study aims to investigate whether serum cystatin C (CysC) can serve as a better marker of RRF than serum creatinine (Cr) in CAPD and to develop a formula to estimate RRF with CysC levels.
METHODS
One hundred and sixty CAPD patients from a single dialysis unit were randomly divided into modeling (n(1) = 120) and validation (n(2) = 40) groups. RRF was assessed as the average of the renal clearances of urea and creatinine. We then derived RRF formulas based on the CysC and Cr levels from the modeling group and validated them by comparison with a published CysC-based equation and Modification of Diet in Renal Disease formula.
RESULTS
CysC levels were inversely related to RRF, Kt/V(urea) and total weekly Ccr but were unrelated to age, gender, body mass index, diabetes or peritoneal clearance. The RRF formulas derived from CysC and Cr were (sinh(ln(6.736-0.566 CysC)))(2) and (sinh(ln(6.097-0.265 Cr)))(2), respectively. When applied to the validation group, the estimated RRF based on CysC (2.8 ± 1.2 mL/min/1.73 m(2)) was similar to that of on Cr (2.8 ± 1.3 mL/min/1.73 m(2)) and the measured RRF (2.9 ± 1.7 mL/min/1.73 m(2)). The CysC formula showed a small bias, with the best 30 and 50% accuracy and had a larger area under the curve and higher sensitivity and specificity when compared to the Cr formula and other formulas.
CONCLUSION
Serum CysC may be a good marker for the estimation of RRF in CAPD patients. The derived CysC formula may be used to reliably estimate RRF in CAPD patients without the need for collection of 24 h urine.