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. 2025 Jan 29;10(4):1248-1259.
doi: 10.1016/j.ekir.2025.01.030. eCollection 2025 Apr.

Discordant Results Between Creatinine- and Cystatin C-based Equations for Estimating GFR

Pierre Delanaye  1   2 , Martin Flamant  3 , Emmanuelle Vidal-Petiot  3 , Jonas Björk  4   5 , Ulf Nyman  6 , Anders Grubb  7 , Stephan J L Bakker  8 , Martin H de Borst  8 , Marco van Londen  8 , Laurence Derain-Dubourg  9 , Andrew D Rule  10 , Björn O Eriksen  11 , Toralf Melsom  11 , Per-Ola Sundin  12 , Natalie Ebert  13 , Elke Schaeffner  13 , Magnus Hansson  14 , Karin Littmann  15 , Anders Larsson  16 , Thomas Stehlé  17   18 , Etienne Cavalier  19 , Justine B Bukabau  20 , Ernest K Sumaili  20 , Eric Yayo  21 , Christophe Mariat  22 , Olivier Moranne  2 , Anders Christensson  23 , Antoine Lanot  24   25   26   27 , Hans Pottel  27
Affiliations

Discordant Results Between Creatinine- and Cystatin C-based Equations for Estimating GFR

Pierre Delanaye et al. Kidney Int Rep. .

Erratum in

Abstract

Introduction: Discordant results between cystatin C and creatinine in estimating glomerular filtration rate (GFR) are an important medical issue. However, the equation that should be used when GFR estimates are discordant remains unclear.

Methods: This cross-sectional analysis included 15,485 participants with GFR measured by the clearance of an exogenous marker, serum creatinine, and cystatin C. We studied the proportion of discordant results defined as an absolute (> 15 ml/min per 1.73 m2) or relative (> 20%) difference between creatinine-based estimated GFR (eGFR, eGFRcrea) and cystatin C-based eGFR (eGFRcys) using different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], European Kidney Function Consortium [EKFC], and reexpressed Lund-Malmö [r-LMR]). We also researched for the best estimating equations to be used in subjects with concordant or discordant results to estimate measured GFR (mGFR).

Results: In the total cohort, the proportion of subjects with discordant results (absolute or relative) was larger for CKD-EPI (35.1 and 40.6%) than for EKFC (21.9 and 31.7%) or r-LMR (22.8 and 32.8%) equations. Among discrepant results, the proportion of eGFRcys < eGFRcrea was significantly higher than the proportion of eGFRcrea < eGFRcys for the CKD-EPI equations, whereas the occurrence of discrepancy was similar in the 2 discrepant groups for EKFC or r-LMR. For the EKFC and r-LMR equations, but not for the CKD-EPI, the equation combining creatinine and cystatin C was consistently the closest to the mGFR in the discrepant groups.

Conclusion: Based on the lower discrepancy proportion, better balance between eGFRcrea and eGFRcys, and better concordance with mGFR, the EKFC, and r-LMR equations should be preferred over the CKD-EPI to estimate GFR.

Keywords: creatinine; cystatin C; glomerular filtration rate.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Association between differences in creatinine and cystatin C-based equations and measured GFR. CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration (1a and c); crea, creatinine; cys, cystatin C; EKFC, European Kidney Function Consortium (1b and 1d). The absolute differences are shown in Figures 1a and b. The green dashed lines are corresponding to the interval of 15 ml/min per 1.73 m2. The relative differences are shown in Figures 1c and d. The green dashed lines correspond to the intervals of 20%. Redlines are the zero-bias line. The grey line corresponds to the regression line. The n values are the number of results beyond the thresholds of 15 ml/min per 1.73 m2 or 20%.
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References

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