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Departments of
1
Medical and Surgical Sciences and
3
Pharmacology and Anesthesiology, University of Padua, Largo E. Meneghetti 2, 35131 Padua, Italy.
2 Department of Laboratory Medicine, University Hospital of Padua, 35128 Padua, Italy.
aAuthor for correspondence. Fax 39-049-8275093; e-mail pietro.palatini{at}unipd.it.
Background: Plasma creatinine concentration and calculated creatinine clearance are of limited value as glomerular filtration rate (GFR) markers in patients with decompensated liver cirrhosis. We assessed plasma cystatin C as an indicator of GFR in such patients.
Methods: We studied 36 patients with decompensated liver cirrhosis and 56 noncirrhotic controls, both groups including individuals with normal and impaired renal function. GFR was measured in all individuals by inulin clearance, with values <72 mL · min-1 · 1.73 m-2 considered decreased. We measured cystatin C and creatinine in plasma and calculated (from plasma concentrations) and measured creatinine clearances, using for them decision points of 1.25 mg/L, 115 µmol/L, and 72 and 72 mL · min-1 · 1.73 m-2, respectively.
Results: Plasma cystatin C concentrations were similar in controls and cirrhotics and, at the usual cutpoint, could detect decreased GFR with similar sensitivities in the two groups (73% and 88%, respectively). Serum creatinine was markedly lower in cirrhotics and remained mostly within the reference interval at all GFR values; the diagnostic sensitivity of creatinine was much lower in cirrhotics than in controls (23% vs 64%). Lower diagnostic sensitivity was also observed for calculated creatinine clearance (53% vs 100% in controls), whereas similar sensitivities were found for measured creatinine clearance (86% and 81%) in controls and cirrhotics, respectively. ROC analysis showed that all four variables had similar diagnostic accuracies in cirrhotic patients. However, it also revealed that good diagnostic accuracies for plasma creatinine and calculated creatinine clearance can be obtained only if reference intervals different from those used for the general population are adopted.
Conclusions: Plasma cystatin C concentration is an accurate GFR marker in cirrhotic patients. Plasma creatinine concentration and calculated creatinine clearance are of no practical value, as their reference values vary with the severity of the liver disease.
The following articles in journals at HighWire Press have cited this article:
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  M. C. Odden, R. Scherzer, P. Bacchetti, L. A. Szczech, S. Sidney, C. Grunfeld, and M. G. Shlipak Cystatin C Level as a Marker of Kidney Function in Human Immunodeficiency Virus Infection: The FRAM Study Arch Intern Med, November 12, 2007; 167(20): 2213 - 2219. [Abstract] [Full Text] [PDF]
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 D. E Nix, B. L Erstad, P. Z Nakazato, J. F Barletta, K. R Matthias, and T. S Krueger Estimation of Creatinine Clearance in End-Stage Liver Disease Ann. Pharmacother., May 1, 2006; 40(5): 900 - 908. [Abstract] [Full Text] [PDF]
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 U. Poge, T. Gerhardt, B. Stoffel-Wagner, H. U. Klehr, T. Sauerbruch, and R. P. Woitas Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients Nephrol. Dial. Transplant., March 1, 2006; 21(3): 660 - 664. [Abstract] [Full Text] [PDF]
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N. L. Proulx, A. Akbari, A. X. Garg, A. Rostom, J. Jaffey, and H. D. Clark Measured creatinine clearance from timed urine collections substantially overestimates glomerular filtration rate in patients with liver cirrhosis: a systematic review and individual patient meta-analysis Nephrol. Dial. Transplant., August 1, 2005; 20(8): 1617 - 1622. [Abstract] [Full Text] [PDF]
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 A. R. Huber and L. Risch Recent Developments in the Evaluation of Glomerular Filtration Rate: Is There a Place for {beta}-Trace? Clin. Chem., August 1, 2005; 51(8): 1329 - 1330. [Full Text] [PDF]
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B. Lumbreras-Lacarra, J. M. Ramos-Rincon, and I. Hernandez-Aguado Methodology in Diagnostic Laboratory Test Research in Clinical Chemistry and Clinical Chemistry and Laboratory Medicine Clin. Chem., March 1, 2004; 50(3): 530 - 536. [Abstract] [Full Text] [PDF]
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