Assessment of estimated glomerular filtration rate based on cystatin C in diabetic nephropathy

Introduction: GFR is estimated by using creatinine and cystatin C to determine renal dysfunction. Our aim was to evaluate estimated GFR (eGFR) based on cystatin C in type 2 diabetic patients with diabetic nephropathy (DN). Methods: Study group included 52 controls (46% male, age: 54.5 +/- 12.4) and 101 diabetic patients (46.5% male, age: 58.2 +/- 11). The diabetics were divided into three subgroups according to 24-hour urine albumin: normal to mildly increased (A1) (n=51), moderately increased (A2) (n=25), severely increased (A3) (n=25) albuminuria. Creatinine clearance (CrCl) was determined. Correlations between CrCl and eGFRs estimated according to the CKD-EPI, MDRD, and Cockcroft- Gault (CG) formulas, and ROC curves were evaluated. Data were analyzed using SPSS 22.0. Results: Only CKD-EPI- cys eGFR was significantly lower in the A1 group than the controls (p=0.021). All GFRs were lower in the A3 group than the control (CKD-EPIcr, MDRD, CKD-EPI- cys, CKD-EPI-crcys: p=0.0001, CG and CrCl: p=0.001) and A1 (for all GFRs p=0.0001) groups. CKD-EPI- cr (p=0.004), MDRD (p=0.01), CG (p=0.037), CKD- EPI-cys (p=0.033), and CKD-EPI-cr-cys (p=0.016) eGFRs in the A2 group were significantly different from the A1 group. All eGFRs showed a moderate correlation with CrCl in the A1group (CKD-EPI-cr and CKD-EPI-crcys: r=0.49, p=0.0001, MDRD: r=0.44, p=0.001, CG r=0.48, p=0.0001: CKDEPI-cys r=0.40, p=0.004). The area under the CKD-EPI-cys ROC curve was the highest and found to be 0.847 (95%CI 0.763-0.931, p=0.0001). Conclusions: Our results showed that the CKD-EPIcys eGFR can be useful in detecting the early stage of DN and more predictive than the others for prediction of DN.