The international organisation KDIGO (Kidney Disease: Improving Global Outcomes) has published the 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD). In the new and revised guideline, the biomarker cystatin C has been assigned a more significant role in estimating glomerular filtration rate (GFR).
The guideline points out the importance of using the most accurate GFR assessment available, which often involves a combination of creatinine and cystatin C. Using cystatin C in combination with creatinine to assess glomerular filtration rate (GFR) offers several benefits in kidney disease management. Cystatin C is advantageous because it is not influenced by factors such as race and diet, and it is less susceptible to variations due to age, muscle mass, and gender.
KDIGO 2024 Guidelines: Cystatin C testing advantages
Accuracy
Cystatin C may provide a more accurate assessment of GFR compared to creatinine, especially in situations where creatinine-based estimates may be inaccurate due to factors like changes in muscle mass, inflammation, or specific medications.
Clinical decision-making
When a more precise evaluation of GFR is crucial for clinical decisions such as diagnosing or staging chronic kidney disease (CKD), cystatin C should be measured alongside creatinine to estimate GFR accurately (eGFRcr-cys).
Improved risk assessment
Incorporating cystatin C measurements into GFR assessments can lead to changes in risk categorization for various outcomes. For example, using eGFRcr-cys instead of eGFRcr can result in more accurate risk associations for complications like kidney failure, cardiovascular disease, heart failure, and mortality.
Personalised treatment
By offering a more reliable estimation of GFR, cystatin C-based assessments can help tailor treatment decisions based on the individual's kidney function status, especially in combination with creatinine. This is particularly important in scenarios where precise dosing of medications is essential for patient care.
In summary - Cystatin C in the KDIGO guidelines
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.
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