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Abstract: TH-PO997

Cystatin C as a Marker for GFR Estimation in Clinical Populations: A Systematic Review

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Adingwupu, Ogechi M., Tufts Medical Center, Boston, Massachusetts, United States
  • Barbosa, Ernesto Rodolpho, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Palevsky, Paul M., VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
  • Vassalotti, Joseph A., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States
  • Inker, Lesley Ann, Tufts Medical Center, Boston, Massachusetts, United States

Group or Team Name

  • CKD-EPI.

GFR estimated using creatinine (eGFRcr) is often inaccurate in populations with acute and chronic illness. The accuracy of GFR equations that use cystatin C (eGFRcys) or creatinine-cystatin C (eGFRcr-cys) is not well studied in these populations.


Using a systematic review, we identified 21 studies of populations with comorbid illnesses that evaluated eGFRcr and eGFRcys compared to measured GFR (mGFR) using standardized assays for the markers: cancer (5); HIV (5); cirrhosis (2); liver transplant (3); heart failure (1); critical illness (3); and obesity (2). The performance of each equation was the unit of analyses (“report”). We assessed equation performance using bias as the median or mean difference between eGFR and mGFR, and accuracy as the percentage of eGFR within 30% of mGFR (P30).


eGFRcr had more reports of moderate-to-large bias than for eGFRcys and eGFRcr-cys, and of overestimation, than underestimatation, of mGFR. There were large inconsistencies in the relative performance of eGFRcr vs eGFRcys even for populations with the same illness. eGFRcr-cys was most accurate in populations with cancer, HIV and obesity, but did not perform consistently better in cirrhosis, liver transplant, heart failure and critical illness populations. Notable limitations are that participants were selected because of concern for inaccurate eGFRcr, and most studies had small sample sizes, limiting generalizability.


eGFRcr-cys improves GFR estimation in populations with a variety of acute and chronic illnesses, supporting current recommendations for more frequent use of cystatin C into more clinical practice. These data provide early evidence base for indications for cystatin C.


  • NIDDK Support