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      Creatinine–Based and Cystatin C–Based GFR Estimating Equations and Their Non-GFR Determinants in Kidney Transplant Recipients

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          Background and objectives

          eGFR equations have been evaluated in kidney transplant recipients with variable performance. We assessed the performance of the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equations on the basis of creatinine, cystatin C, and both (eGFR creatinine-cystatin C) compared with measured GFR by iothalamate clearance and evaluated their non-GFR determinants and associations across 15 cardiovascular risk factors.

          Design, setting, participants, & measurements

          A cross-sectional cohort of 1139 kidney transplant recipients >1 year after transplant was analyzed. eGFR bias, precision, and accuracy (percentage of estimates within 30% of measured GFR) were assessed. Interaction of each cardiovascular risk factor with eGFR relative to measured GFR was determined.


          Median measured GFR was 55.0 ml/min per 1.73 m 2. eGFR creatinine overestimated measured GFR by 3.1% (percentage of estimates within 30% of measured GFR of 80.4%), and eGFR Modification of Diet in Renal Disease underestimated measured GFR by 2.2% (percentage of estimates within 30% of measured GFR of 80.4%). eGFR cystatin C underestimated measured GFR by −13.7% (percentage of estimates within 30% of measured GFR of 77.1%), and eGFR creatinine-cystatin C underestimated measured GFR by −8.1% (percentage of estimates within 30% of measured GFR of 86.5%). Lower measured GFR associated with older age, women, obesity, longer time after transplant, lower HDL, lower hemoglobin, lower albumin, higher triglycerides, higher proteinuria, and an elevated cardiac troponin T level but did not associate with diabetes, smoking, cardiovascular events, pretransplant dialysis, or hemoglobin A1c. These risk factor associations differed for five risk factors with eGFR creatinine, six risk factors for eGFR Modification of Diet in Renal Disease, ten risk factors for eGFR cystatin C, and four risk factors for eGFR creatinine-cystatin C.


          Thus, eGFR creatinine and eGFR creatinine-cystatin C are preferred over eGFR cystatin C in kidney transplant recipients because they are less biased, more accurate, and more consistently reflect the same risk factor associations seen with measured GFR.

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          Author and article information

          Clin J Am Soc Nephrol
          Clin J Am Soc Nephrol
          Clinical Journal of the American Society of Nephrology : CJASN
          American Society of Nephrology
          7 September 2016
          23 June 2016
          : 11
          : 9
          : 1640-1649
          [* ]Division of Nephrology and Hypertension, Mayo Clinic, Phoenix, Arizona; and
          []Division of Nephrology and Hypertension,
          []Renal Laboratory, Department of Laboratory Medicine and Pathology, and
          [§ ]Department of Health Sciences Research Laboratory, Mayo Clinic, Rochester, Minnesota
          Author notes
          Correspondence: Dr. Mira T. Keddis, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054. Email: keddis.mira@ 123456mayo.edu
          PMC5012488 PMC5012488 5012488 11741115
          Copyright © 2016 by the American Society of Nephrology
          Page count
          Figures: 2, Tables: 4, Equations: 0, References: 40, Pages: 10
          Original Articles
          Renal Transplantation
          Custom metadata
          September 07, 2016


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