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Creatinine- versus cystatine C-based equations in assessing the renal function of candidates for liver transplantation with cirrhosis

Authors

  • Vandréa De Souza,

    1. Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, France
    2. Post-Graduate Program in Medical Sciences, FAMED-Programa de Pós Graduação em Saúde da Criança e do Adolescente-Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
    3. Universidade de Caxias do Sul, Centro de Ciências da Saúde, School of Medicine, Brazil
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  • Aoumeur Hadj-Aissa,

    1. Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, France
    2. Université Claude-Bernard, Lyon, France
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  • Olga Dolomanova,

    1. Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, France
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  • Muriel Rabilloud,

    1. Université Claude-Bernard, Lyon, France
    2. Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
    3. CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
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  • Nicolas Rognant,

    1. Département de Néphrologie, Hospices Civils de Lyon, Lyon, France
    2. INSERM UMR 1060, Université Claude Bernard-Lyon 1, Lyon, France
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  • Sandrine Lemoine,

    1. Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, France
    2. Département de Néphrologie, Hospices Civils de Lyon, Lyon, France
    3. INSERM UMR 1060, Université Claude Bernard-Lyon 1, Lyon, France
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  • Sylvie Radenne,

    1. Service d'Hépatologie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
    2. INSERM U 1052, Lyon, France
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  • Jérôme Dumortier,

    1. Hépato-Gastroentérologie, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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  • Colette Chapuis-Cellier,

    1. Université Claude-Bernard, Lyon, France
    2. Centre de Biologie Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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  • Françoise Beyerle,

    1. Laboratoire de Biochimie et Biologie Moléculaire, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
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  • Chantal Bon,

    1. Laboratoire de Biochimie et Biologie Moléculaire, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
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  • Jean Iwaz,

    1. Université Claude-Bernard, Lyon, France
    2. Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
    3. CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
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  • Luciano Selistre,

    1. Universidade de Caxias do Sul, Centro de Ciências da Saúde, School of Medicine, Brazil
    2. Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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  • Laurence Dubourg

    Corresponding author
    1. Exploration Fonctionnelle Rénale et Métabolique, Groupement Hospitalier Edouard Herriot, France
    2. Université Claude-Bernard, Lyon, France
    3. UMR 5305 CNRS/Université Claude-Bernard, Biologie tissulaire et Ingénierie thérapeutique, Lyon, France
    • Address reprint requests to: Laurence Dubourg, Exploration Fonctionnelle Rénale et Métabolique, Pavillon P, Hôpital Edouard Herriot, 5, Place d'Arsonval, F-69437 Lyon Cedex 03, France. E-mail: laurence.dubourg@chu-lyon.fr; fax: +33 4 72 11 67 80.

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  • Potential conflict of interest: Nothing to report.

Abstract

Renal dysfunction is frequent in liver cirrhosis and is a strong prognostic predictor of orthotopic liver transplantation (OLT) outcome. Therefore, an accurate evaluation of the glomerular filtration rate (GFR) is crucial in pre-OLT patients. However, in these patients plasma creatinine (Pcr) is inaccurate and the place of serum cystatine C (CystC) is still debated. New GFR-predicting equations, based on standardized assays of Pcr and/or CystC, have been recently recommended in the general population but their performance in cirrhosis patients has been rarely studied. We evaluated the performance of the recently published Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI-Pcr, CKD-EPI-CystC, and CKD-EPI-Pcr-CystC) and the more classical ones (4- and 6-variable MDRD and Hoek formulas) in cirrhosis patients referred for renal evaluation before OLT. Inulin clearance was performed in 202 consecutive patients together with the determination of Pcr and CystC with assays traceable to primary reference materials. The performance of the GFR-predicting equations was evaluated according to ascites severity (no, moderate, or refractory) and to hepatic and renal dysfunctions (MELD score ≤ or >15 and KDOQI stages, respectively). In the whole population, CystC-based equations showed a better performance than Pcr-based ones (lower bias and higher 10% and 30% accuracies). CKD-EPI-CystC equation showed the best performance whatever the ascites severity and in presence of a significant renal dysfunction (GFR <60 mL/min/1.73 m2). Conclusion: Pcr-based GFR predicting equations are not reliable in pre-OLT patients even when an IDMS-traceable enzymatic Pcr assay is used. Whenever a CystC-assay traceable to primary reference materials is performed and when a true measurement of GFR is not possible, CystC-based equations, especially CKD-EPI-CystC, may be recommended to evaluate renal function and for KDOQI staging. (Hepatology 2014;59:1522-1531)

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