What is the best glomerular filtration marker to identify people with chronic kidney disease most likely to have poor outcomes?

A meta-analysis of data from 16 studies including more than 90000 participants found that use of cystatin C in addition to creatinine predicted risk of kidney failure and death more accurately. 14 These observations have been confirmed in other large scale studies in general and disease populations....

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Published in:	BMJ (Online) 2015-01, Vol.350 (jan12 3), p.g7667-g7667
Main Authors:	Lamb, E J, Stevens, P E, Deeks, J J
Format:	Article
Language:	eng
Subjects:	Biomarkers Cardiovascular disease Disease Progression Glomerular Filtration Rate - physiology Humans Laboratories Mass Screening - methods Mortality Predictive Value of Tests Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - etiology Renal Insufficiency, Chronic - physiopathology UNCERTAINTIES PAGE
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Summary:	A meta-analysis of data from 16 studies including more than 90000 participants found that use of cystatin C in addition to creatinine predicted risk of kidney failure and death more accurately. 14 These observations have been confirmed in other large scale studies in general and disease populations. 11 13 15 16 17 Increasing cystatin C concentration predicts increased risk independently of GFR. 18 This phenomenon (improved predictive ability over and above any improvement in GFR estimation) has been attributed to (as yet undefined) non-GFR determinants of serum cystatin C concentration that predict outcome. 19 Cystatin C based GFR estimation has been proposed as a useful confirmatory test of chronic kidney disease associated risk in the largest identified group of patients with chronic kidney disease (that is, those with GFR between 45 and 59 mL/min/1.73 m2 and no albuminuria). Base frequency of monitoring on recent consensus based guidance, with significant change being regarded as that exceeding normal biological and analytical variation. 1 7 NICE also recommends tailoring frequency of monitoring according to factors such as the cause of chronic kidney disease, comorbidities, intercurrent illness, changes in treatment, and whether patients have chosen conservative management. 7 Recommendation for further research Among people with chronic kidney disease, which glomerular filtration marker(s) can improve prediction of future adverse outcomes compared with current creatinine based estimates of glomerular filtration rate?
ISSN:	0959-8138 1756-1833 1756-1833