Early Detection of Renal Impairment Among Patients with Type 2 Diabetes Mellitus Through Evaluation of Serum Cystatin C in Comparison with Serum Creatinine Levels: A Cross-Sectional Study

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Abstract

Background

The proportion of patients with end-stage renal disease caused by diabetes has progressively increased during the last few decades. Serum creatinine level is the most commonly used biochemical parameter to estimate GFR in routine practice. However, 50% of GFR can be lost before significant elevation of serum creatinine. Cystatin C is found to be a new promising marker for early detection of renal diseases.

Objective of the Study

The aim of this study was to determine the value of serum cystatin C and serum creatinine levels for early detection of renal disease in patients with type 2 diabetes mellitus.

Methodology

A hospital-based comparative cross-sectional study was conducted with a sample size of 120. For early detection of renal disease in patients with type 2 diabetes mellitus, serum creatinine and cystatin C levels were measured and compared.

Result and Discussion

Serum creatinine and cystatin C levels were significantly increased in patients with type 2 diabetes mellitus compared to healthy controls. The mean±SD value of serum creatinine was found to be 0.87±0.44 mg/dL in patients and 0.63±0.27 mg/dL in control. Serum cystatin C level was also found to be significantly ( P=0.0001) higher in patients (0.92±0.38 mg/L) compared to controls (0.52±0.20 mg/L). The mean±SD of eGFR in three equations (Creatinine Equation, Cystatin C Equation, and Creatinine–Cystatin C Equation) were 105.7±27.5 mL/min/m ², 90.4±28.2 mL/min/m ², and 100±29.5 mL/min/m ², respectively.

Conclusion

Cystatin C-based GFR estimation equations detect renal impairment in patients with type 2 diabetes mellitus earlier than creatinine-based GFR estimation equations.

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Most cited references 20

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Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease.

Michael Shlipak, H. B. Newman, Mark J. Sarnak … (2006)

Cystatin C is an alternative measure of kidney function that may have prognostic importance among elderly persons who do not meet standard criteria for chronic kidney disease (estimated glomerular filtration rate [GFR] > or =60 mL/min per 1.73 m2). To evaluate cystatin C as a prognostic biomarker for death, cardiovascular disease, and incident chronic kidney disease among elderly persons without chronic kidney disease. Cohort study. The Cardiovascular Health Study, a population-based cohort recruited from 4 communities in the United States. 4663 elderly persons. Measures of kidney function were creatinine-based estimated GFR by using the Modification of Diet in Renal Disease equation and cystatin C concentration. Outcomes were death, cardiovascular death, noncardiovascular death, heart failure, stroke, myocardial infarction, and incident chronic kidney disease during follow-up (median, 9.3 years). At baseline, 78% of participants did not have chronic kidney disease (estimated GFR > or =60 mL/min per 1.73 m2) and mean cystatin C concentration, creatinine concentration, and estimated GFR were 1.0 mg/L, 79.6 micromol/L (0.9 mg/dL), and 83 mL/min per 1.73 m2, respectively. Cystatin C concentrations (per SD, 0.18 mg/L) had strong associations with death (hazard ratio, 1.33 [95% CI, 1.25 to 1.40]), cardiovascular death (hazard ratio, 1.42 [CI, 1.30 to 1.54]), noncardiovascular death (hazard ratio, 1.26 [CI, 1.17 to 1.36]), incident heart failure (hazard ratio, 1.28 [CI, 1.17 to 1.40]), stroke (hazard ratio, 1.22 [CI, 1.08 to 1.38]), and myocardial infarction (hazard ratio, 1.20 [CI, 1.06 to 1.36]) among these participants. Serum creatinine concentrations had much weaker associations with each outcome and only predicted cardiovascular death. Participants without chronic kidney disease who had elevated cystatin C concentrations (> or =1.0 mg/L) had a 4-fold risk for progressing to chronic kidney disease after 4 years of follow-up compared with those with cystatin C concentrations less than 1.0 mg/L. Because this study did not directly measure GFR or albuminuria, the extent to which cystatin C may be influenced by nonrenal factors was not determined and participants with albuminuria might have been misclassified as having no kidney disease. Among elderly persons without chronic kidney disease, cystatin C is a prognostic biomarker of risk for death, cardiovascular disease, and chronic kidney disease. In this setting, cystatin C seems to identify a "preclinical" state of kidney dysfunction that is not detected with serum creatinine or estimated GFR.

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Initial evaluation of cystatin C measurement by particle-enhanced immunonephelometry on the Behring nephelometer systems (BNA, BN II).

P Merle, H. Finney, Catherine Price … (1997)

Serum cystatin C has been suggested as a new marker of glomerular filtration rate (GFR). We describe a fully automated and rapid particle-enhanced nephelometric immunoassay (PENIA) for measuring serum cystatin C on the Behring nephelometer systems (BNA, BN II). Each sample is analyzed in 6 min with as many as 75 samples per batch. The assay covers the range 0.23-7.25 mg/L, up to seven times the upper limit of normal. The intra- and interassay imprecision are < 3.3% and < 4.5%, respectively. There is absolute linearity across the assay range (r2 = 0.997), with analytical recovery by cystatin C addition between 95% and 109% (mean 102%). Hemoglobin (< or = 8.0 g/L), bilirubin (< or = 488 microL), triglycerides (< or = 23 mmol/L), rheumatoid factor (< or = 2000 kIU/L), and myeloma paraprotein (< or = 41 g/L) do not interfere with the assay. This assay agreed well with an in-house particle-enhanced turbidimetric immunoassay (PETIA) (mean difference = 1.73 +/- 2.10) and a commercial PETIA (mean difference = 1.13 +/- 0.86). This is a new assay by which cystatin C may be effectively used as a marker of GFR estimation.

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Association of cystatin C with mortality, cardiovascular events, and incident heart failure among persons with coronary heart disease: data from the Heart and Soul Study.

Joachim H. Ix, Michael Shlipak, Glenn Chertow … (2007)

Serum creatinine and related estimating equations predict cardiovascular events and mortality among persons with coronary heart disease (CHD). Cystatin C is a novel and sensitive endogenous marker of kidney function. Whether cystatin C concentrations are associated with adverse events among ambulatory persons with CHD is unknown. Nine hundred ninety ambulatory persons with CHD were categorized into quartiles of serum cystatin C at inception, with or = 1.30 mg/L constituting the highest (IV). Cox proportional hazards models evaluated time to all-cause mortality, cardiovascular events (composite of CHD death, myocardial infarction, and stroke), and incident heart failure. After a median follow-up of 37 months, 132 participants (13%) died, 101 (10%) had cardiovascular events, and 57 (7%) had incident heart failure. Compared with participants in the lowest cystatin C quartile, those in the highest quartile were at increased risk of all-cause mortality (hazard ratio, 3.6; 95% CI, 1.8 to 7.0), cardiovascular events (hazard ratio, 2.0; 95% CI, 1.0 to 3.8), and incident heart failure (hazard ratio, 2.6; 95% CI, 1.0 to 6.9) in analyses adjusted for traditional cardiovascular risk factors. Cystatin C in the highest quartile predicted similar risk for these outcomes among participants with lower (< or = 60 mL/min per 1.73 m2) or higher estimated glomerular filtration rate and among participants with or without microalbuminuria. High cystatin C concentrations predict substantial increased risks of all-cause mortality, cardiovascular events, and incident heart failure among ambulatory persons with CHD. This risk is not completely captured by measures of kidney function routinely used in clinical practice.

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Author and article information

Journal

Journal ID (nlm-ta): Diabetes Metab Syndr Obes

Journal ID (iso-abbrev): Diabetes Metab Syndr Obes

Journal ID (publisher-id): dmso

Journal ID (pmc): dmso

Title: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy

Publisher: Dove

ISSN (Electronic): 1178-7007

Publication date (Electronic): 03 December 2020

Publication date Collection: 2020

Volume: 13

Pages: 4727-4735

Affiliations

[1 ]Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar , Gondar, Ethiopia

[2 ]Department of Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University , Addis Ababa, Ethiopia

[3 ]Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University , Addis Ababa, Ethiopia

[4 ]Department of Biochemistry, College of Health Sciences, Debre Tabor University , Debre Tabor, Ethiopia

[5 ]National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute , Addis Ababa, Ethiopia

Author notes

Correspondence: Tadesse Asmamaw Email as24tadesse@gmail.com

Author information

Solomon Genet http://orcid.org/0000-0002-5433-0107

Getahun Tarekegn http://orcid.org/0000-0002-1480-5542

Endeshaw Chekol http://orcid.org/0000-0002-5035-6633

Zeleke Geto http://orcid.org/0000-0001-8332-8885

Tigist Getahun http://orcid.org/0000-0001-6899-7247

Yosef Tolcha http://orcid.org/0000-0002-0783-8127

Article

Publisher ID: 279949

DOI: 10.2147/DMSO.S279949

PMC ID: 7721116

SO-VID: bfb809d8-36a7-4566-a61b-82d341de9a53

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 04 September 2020

Date accepted : 12 November 2020

Page count

Figures: 2, Tables: 12, References: 23, Pages: 9

Funding

Funded by: Ethiopian Public Health Institution (EPHI) in;

This work was supported both financially and materially by Ethiopian Public Health Institution (EPHI) in collaboration with Addis Ababa University.

Early Detection of Renal Impairment Among Patients with Type 2 Diabetes Mellitus Through Evaluation of Serum Cystatin C in Comparison with Serum Creatinine Levels: A Cross-Sectional Study

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Abstract

Background

Objective of the Study

Methodology

Result and Discussion

Conclusion

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 20

Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease.

Initial evaluation of cystatin C measurement by particle-enhanced immunonephelometry on the Behring nephelometer systems (BNA, BN II).

Association of cystatin C with mortality, cardiovascular events, and incident heart failure among persons with coronary heart disease: data from the Heart and Soul Study.

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