The global non-profit organisation KDIGO (Kidney Disease: Improving Global Outcomes), commits to create and execute evidence-based clinical practice guidelines for kidney diseases. The organisation has recently released the 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD).
The 2024 guideline assigns cystatin C a more prominent role in estimating glomerular filtration rate (GFR), due to its improved accuracy compared to creatinine alone, as cystatin C is not influenced by race and diet and is less affected by age, muscle mass and gender.1,2
Use of biomarkers in diagnostic and monitoring
Glomerular Filtration Rate (GFR) represents the best overall index of kidney function. The KDIGO-guideline points out the importance of using the most accurate GFR assessment available, which often involves a combination of the biomarkers creatinine and cystatin C.
Although, creatinine is more commonly utilised today, cystatin C is gaining popularity due to its ability to provide a more accurate assessment of GFR. This is particularly relevant in cases where creatinine-based estimates may be unreliable due to changes in muscle mass.
Patient groups benefiting from combined cystatin C and creatinine
The KDIGO CKD 2024 guidelines emphasise the utility of combining cystatin C (cys) and creatinine (cr) to estimate GFR (eGFR) in three key patient groups: frail individuals, those needing precise GFR assessment for clinical decisions, and individuals at elevated risk of kidney disease complications.
Frail individuals
In people who are frail or have multiple comorbid illnesses, eGFRcr-cys may be more accurate than eGFRcr alone due to large contributions from non-GFR determinants of creatinine, cystatin C, or both markers. This population may benefit significantly from the enhanced accuracy provided by the combination of cystatin C and creatinine for GFR estimation.
Patients requiring precise GFR assessment
Healthcare providers should consider using a combination of creatinine and cystatin C for estimating GFR in situations where a highly accurate level of GFR is crucial for clinical decision-making. This is particularly important in diagnosing or staging chronic kidney disease (CKD) and determining appropriate drug dosing based on accurate kidney function assessment.*
Individuals with risk factors for kidney disease complications
Incorporating cystatin C alongside creatinine can lead to changes in risk categorization for various outcomes such as kidney failure, cardiovascular disease, heart failure, and mortality. Therefore, patient populations at higher risk of these complications may benefit from the more accurate risk associations provided by eGFRcr-cys compared to eGFRcr alone.
Cystatin C alongside creatinine for a more reliable method
While recognising the additional costs associated with cystatin C testing, KDIGO encourage healthcare providers to balance these costs against the potential benefits of more precise risk assessment and clinical decision-making. Utilising cystatin C alongside creatinine for GFR assessment provides a more accurate and reliable method for evaluating kidney function, enabling better clinical decision-making and personalised treatment strategies in the management of kidney diseases.
The Gentian Cystatin C Immunoassay
Gentian's cystatin C immunoassay is applied to turbidimetry-based clinical chemistry platforms. It is an open channel assay, meaning it can be added to all clinical chemistry analysers.
- FDA510(k) cleared since 2008
- CE-marked and IVDR certified
- Developed and manufactured by Gentian
- Manufactured according to ISO 13485:2016
Contact us
Explore cystatin C in your clinical practise or laboratory - fill out the form or send an email to marketing@gentian.com for more information about the product and prices.
References:
- Nitsch D et al. Fetal, developmental, and parental influences on cystatin C in childhood: the Uppsala Family Study. Am J Kidney Dis. 2011
- Tangri N et al. Changes in dietary protein intake has no effect on serum cystatin C levels independent of the glomerular filtration rate. Kidney Int. 2011
* Note: in some cases a measured GFR is necessary
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