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Review
. 2022 Aug 23;3(10):1807-1814.
doi: 10.34067/KID.0003202022. eCollection 2022 Oct 27.

Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR

Debbie C Chen  1 , O Alison Potok  2 , Dena Rifkin  2 , Michelle M Estrella  1
Affiliations
Review

Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR

Debbie C Chen et al. Kidney360. .

Abstract

Cystatin C has been shown to be a reliable and accurate marker of kidney function across diverse populations. The 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommended using cystatin C to confirm the diagnosis of chronic kidney disease (CKD) determined by creatinine-based estimated glomerular filtration rate (eGFR) and to estimate kidney function when accurate eGFR estimates are needed for clinical decision-making. In the efforts to remove race from eGFR calculations in the United States, the National Kidney Foundation (NKF) and American Society of Nephrology (ASN) Joint Task Force recommended increasing availability and clinical adoption of cystatin C to assess kidney function. This review summarizes the key advantages and limitations of cystatin C use in clinical practice. Our goals were to review and discuss the literature on cystatin C; understand the evidence behind the recommendations for its use as a marker of kidney function to diagnose CKD and risk stratify patients for adverse outcomes; discuss the challenges of its use in clinical practice; and guide clinicians on its interpretation.

Keywords: clinical nephrology; cystatin C; eGFR.

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Conflict of interest statement

M.M. Estrella reports consultancy for Eiland & Bonnin, PC; research funding from Bayer and Booz Allen Hamilton; honoraria from the American Kidney Fund, AstraZeneca, and Boehringer Ingelheim, Inc.; and an advisory or leadership role for CJASN (editorial board member) and the American Journal of Kidney Disease (editorial board member). D.E. Rifkin reports an advisory or leadership role for the ABIM Nephrology Exam Committee and the American Journal of Kidney Disease (editorial board feature editor), and being a co-investigator, US site, for the EMPA-KIDNEY study (pending). All remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
CKD stage reclassification by the cystatin C–based eGFR equation relative to the race-free creatinine-based GFR equation (16).
Figure 2.
Figure 2.
Clinical scenarios in which serum creatinine is likely influenced by non-GFR factors.
Figure 3.
Figure 3.
Drug effects on kidney tubular creatinine secretion (–45).
See this image and copyright information in PMC

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