Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery
Introduction: Current guidelines recommend creatinine-based estimated glomerular filtration rate (eGFRcr) to assess kidney recovery after acute kidney injury (AKI); however, this may be inaccurate because of loss of muscle mass. Cystatin C-based eGFR (eGFRcys) is an alternative that is not similarly...
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Elsevier
2025-08-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024925002918 |
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| author | Kerry L. Horne Rebecca Packington John Monaghan Mary Jo Kurth Ciaran Richardson Mark W. Ruddock Maarten W. Taal Rosamonde E. Banks Nicholas M. Selby |
| author_facet | Kerry L. Horne Rebecca Packington John Monaghan Mary Jo Kurth Ciaran Richardson Mark W. Ruddock Maarten W. Taal Rosamonde E. Banks Nicholas M. Selby |
| author_sort | Kerry L. Horne |
| collection | DOAJ |
| description | Introduction: Current guidelines recommend creatinine-based estimated glomerular filtration rate (eGFRcr) to assess kidney recovery after acute kidney injury (AKI); however, this may be inaccurate because of loss of muscle mass. Cystatin C-based eGFR (eGFRcys) is an alternative that is not similarly affected. In addition, simple calculations (e.g., creatinine muscle index, CMI) incorporating the difference between eGFRcr and eGFRcys may indicate prognosis. We sought to determine whether eGFRcr differs from eGFRcys after AKI and whether CMI is associated with mortality. Methods: The AKI Risk in Derby (ARID) study is a prospective parallel-group cohort study. Hospitalized participants with and without exposure to AKI were matched 1:1 for age, baseline kidney function, and diabetes. eGFRcr and eGFRcys at 3 months after admission were compared in 849 participants. Associations between CMI and outcomes, including mortality, heart failure, and hospitalization were assessed at 5 years. Results: eGFRcys was lower than eGFRcr (53.4, [interquartile range, IQR: 34.3–85.5] vs. 68.4 [IQR: 52.5–84.7] ml/min per 1.73 m2, P < 0.001), with more pronounced differences in those with AKI. eGFRcys categorized more participants with chronic kidney disease (CKD) (in AKI group: eGFRcr < 60 ml/min per 1.73 m2 in 44.9%; eGFRcys < 60 ml/min per 1.73 m2 in 69.6%, P < 0.001). In the AKI group, higher CMI was independently associated with lower mortality at 5 years (adjusted hazard ratio: 0.931 [0.874–0.992] mg/d per 1.73 m2, P = 0.03). Conclusion: There are significant differences at 3 months after AKI in eGFR derived from creatinine versus cystatin C. The magnitude of difference between these estimates is associated with subsequent mortality. Further research is required to determine the optimal approach to patient assessment after AKI. |
| format | Article |
| id | doaj-art-deaa0cda6ff14ccf92cec320e599483a |
| institution | DOAJ |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-deaa0cda6ff14ccf92cec320e599483a2025-08-20T02:52:56ZengElsevierKidney International Reports2468-02492025-08-011082741275010.1016/j.ekir.2025.05.004Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury RecoveryKerry L. Horne0Rebecca Packington1John Monaghan2Mary Jo Kurth3Ciaran Richardson4Mark W. Ruddock5Maarten W. Taal6Rosamonde E. Banks7Nicholas M. Selby8Centre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Renal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UKRenal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UKDepartment of Chemical Pathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UKRandox Laboratories Ltd, Crumlin, UKImmunoassay Research and Development Department, Randox Teoranta, Donegal, IrelandRandox Laboratories Ltd, Crumlin, UKCentre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Renal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UKClinical and Biomedical Proteomics Group, Leeds Institute of Medical Research, University of Leeds, UKCentre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Renal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Correspondence: Nicholas M. Selby, Centre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Rd, Derby, DE22 3DT, UK.Introduction: Current guidelines recommend creatinine-based estimated glomerular filtration rate (eGFRcr) to assess kidney recovery after acute kidney injury (AKI); however, this may be inaccurate because of loss of muscle mass. Cystatin C-based eGFR (eGFRcys) is an alternative that is not similarly affected. In addition, simple calculations (e.g., creatinine muscle index, CMI) incorporating the difference between eGFRcr and eGFRcys may indicate prognosis. We sought to determine whether eGFRcr differs from eGFRcys after AKI and whether CMI is associated with mortality. Methods: The AKI Risk in Derby (ARID) study is a prospective parallel-group cohort study. Hospitalized participants with and without exposure to AKI were matched 1:1 for age, baseline kidney function, and diabetes. eGFRcr and eGFRcys at 3 months after admission were compared in 849 participants. Associations between CMI and outcomes, including mortality, heart failure, and hospitalization were assessed at 5 years. Results: eGFRcys was lower than eGFRcr (53.4, [interquartile range, IQR: 34.3–85.5] vs. 68.4 [IQR: 52.5–84.7] ml/min per 1.73 m2, P < 0.001), with more pronounced differences in those with AKI. eGFRcys categorized more participants with chronic kidney disease (CKD) (in AKI group: eGFRcr < 60 ml/min per 1.73 m2 in 44.9%; eGFRcys < 60 ml/min per 1.73 m2 in 69.6%, P < 0.001). In the AKI group, higher CMI was independently associated with lower mortality at 5 years (adjusted hazard ratio: 0.931 [0.874–0.992] mg/d per 1.73 m2, P = 0.03). Conclusion: There are significant differences at 3 months after AKI in eGFR derived from creatinine versus cystatin C. The magnitude of difference between these estimates is associated with subsequent mortality. Further research is required to determine the optimal approach to patient assessment after AKI.http://www.sciencedirect.com/science/article/pii/S2468024925002918acute kidney injurychronic kidney diseasecreatininecystatin CeGFR |
| spellingShingle | Kerry L. Horne Rebecca Packington John Monaghan Mary Jo Kurth Ciaran Richardson Mark W. Ruddock Maarten W. Taal Rosamonde E. Banks Nicholas M. Selby Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery Kidney International Reports acute kidney injury chronic kidney disease creatinine cystatin C eGFR |
| title | Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery |
| title_full | Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery |
| title_fullStr | Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery |
| title_full_unstemmed | Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery |
| title_short | Comparing Cystatin C Estimated GFR With Creatinine Estimated GFR in Acute Kidney Injury Recovery |
| title_sort | comparing cystatin c estimated gfr with creatinine estimated gfr in acute kidney injury recovery |
| topic | acute kidney injury chronic kidney disease creatinine cystatin C eGFR |
| url | http://www.sciencedirect.com/science/article/pii/S2468024925002918 |
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