HDCN Abstract:  ASN Annual Meeting -- San Diego  

Nejat M, Pickering JW, Endre ZH.

Plasma Cystatin C Increases before Plasma Creatinine in Intensive Care Unit Patients.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:357A 2009

Plasma creatinine (Cr) is the standard surrogate marker for altered kidney function and diagnosis of Acute Kidney Injury (AKI), despite major limitations. Plasma cystatin C (CysC) has been proposed as an alternative. We prospectively evaluated whether the rate of rise of CysC was faster than the rate of rise of Cr in individual patients in patients who showed a significant change in renal function.

Blood samples for Cr and CysC were collected from consecutive patients in two intensive care units on admission, at 12 and 24hrs, then daily for 7 days. Patients were excluded if Cr>4.0mg/dl, or they were not expected to survive or remain in the intensive care unit for at least 24 hours, under 16 years, were receiving or expected to receive renal replacement therapy within 48hrs, diagnosed with hematuria, rhabdomyolysis and/or myoglobinuria, or polycythemia, or were receiving erythropoietin. Patients were followed for 30 days.

We defined a significant change in renal function (RF) as a 25% or greater increase in Cr (RF-Cr) or CysC (RF-CysC) from the plasma sample on admission (baseline). Pre-admission CysC samples were not available; hence for comparative analysis on-admission samples were used as baseline for both Cr and CysC. Individual patients were classified as: (A) no significant change in renal function, or (B) RF-Cr preceded RF-CysC, or (C) RF-CysC preceded RF- Cr, or (D) RF-Cr = RF-CysC. If a patient was classified as RF-Cr and not RF- CysC throughout seven days it was assumed RF-Cr preceded RF-CysC and vice versa.
Of 444 patients, 244 had no significant change in renal function from admission (A). RF-Cr preceded RF-CysC in 35 patients (B, 17.5% of the RF population), RF-CysC preceded RF-Cr in 122 patients (C, 61%) and RF-Cr and RF -CysC occurred simultaneously in 43 patients (D, 21.5%), p<0.001.
Of the 64 patients who died within 30 days, more had a significant rise in cystatin C prior to death (RF-CysC, n=35, 55%) than in plasma creatinine (RF- Cr, n=22, 34%), p<0.005.

Plasma Cystatin C is elevated in more patients and earlier than plasma creatinine.

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