Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation

Background: The Fontan circulation is associated with low skeletal muscle mass, which affects the accuracy of creatinine-based glomerular filtration rate estimates (eGFR/GFR). Cystatin C, another filtration marker, is less impacted by muscle mass. We examined associations between characteristics of...

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Autores principales:	David A. Katz, Adam M. Lubert, Zhiqian Gao, Adam W. Powell, Cassandra Szugye, Shalayna Woodly, Stuart L. Goldstein, Tarek Alsaied, Alexander R. Opotowsky
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Fontan operation Adult congenital heart disease Glomerular filtration rate Creatinine Cystatin C Chronic kidney disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/a584612bc4d14d51ab132644a5f146cc
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spelling	oai:doaj.org-article:a584612bc4d14d51ab132644a5f146cc2021-11-18T04:52:36ZComparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation2666-668510.1016/j.ijcchd.2021.100286https://doaj.org/article/a584612bc4d14d51ab132644a5f146cc2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S266666852100210Xhttps://doaj.org/toc/2666-6685Background: The Fontan circulation is associated with low skeletal muscle mass, which affects the accuracy of creatinine-based glomerular filtration rate estimates (eGFR/GFR). Cystatin C, another filtration marker, is less impacted by muscle mass. We examined associations between characteristics of individuals with a Fontan circulation and both creatinine-based and cystatin C-based eGFR. Methods and results: This single-center retrospective study included 107 individuals with a Fontan circulation who had clinical measurements of serum cystatin C and creatinine. GFR was estimated using different equations for adults (≥19 years of age, Chronic Kidney Disease-Epidemiology Collaboration equations for both creatinine and cystatin C) and children (<19 years of age, Schwartz and Larsson equations, for creatinine and cystatin C, respectively). Chronic kidney disease (CKD) was defined as an eGFR <90 mL/min/1.73 m2.Mean eGFR was 115.2 ± 23.9 by creatinine, and 113.6 ± 22.7 mL/min/1.73 m2 by cystatin C. CKD was identified in 16 individuals. Those with CKD as defined by cystatin C had a lower median platelet count (163 [115, 194] vs. 191 [153, 252] p = 0.048), had lower saturations (87.5% [85.3%, 94%] vs. 94% [91%, 95%], p = 0.006) and were more likely to have at least moderate atrioventricular valve regurgitation (31% vs. 7%, p = 0.01). While the same number of patients were classified as having CKD using creatinine-based equations, creatinine-based CKD was only associated with lower saturations (92% [85.3%, 93.8%] vs. 94% [91%, 95%], p = 0.02). Conclusions: Among individuals with a Fontan circulation, defining CKD based on cystatin C rather than creatinine appears to identify a group of patients with characteristics associated with increased risk for clinical deterioration.David A. KatzAdam M. LubertZhiqian GaoAdam W. PowellCassandra SzugyeShalayna WoodlyStuart L. GoldsteinTarek AlsaiedAlexander R. OpotowskyElsevierarticleFontan operationAdult congenital heart diseaseGlomerular filtration rateCreatinineCystatin CChronic kidney diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology Congenital Heart Disease, Vol 6, Iss , Pp 100286- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Fontan operation Adult congenital heart disease Glomerular filtration rate Creatinine Cystatin C Chronic kidney disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Fontan operation Adult congenital heart disease Glomerular filtration rate Creatinine Cystatin C Chronic kidney disease Diseases of the circulatory (Cardiovascular) system RC666-701 David A. Katz Adam M. Lubert Zhiqian Gao Adam W. Powell Cassandra Szugye Shalayna Woodly Stuart L. Goldstein Tarek Alsaied Alexander R. Opotowsky Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation
description	Background: The Fontan circulation is associated with low skeletal muscle mass, which affects the accuracy of creatinine-based glomerular filtration rate estimates (eGFR/GFR). Cystatin C, another filtration marker, is less impacted by muscle mass. We examined associations between characteristics of individuals with a Fontan circulation and both creatinine-based and cystatin C-based eGFR. Methods and results: This single-center retrospective study included 107 individuals with a Fontan circulation who had clinical measurements of serum cystatin C and creatinine. GFR was estimated using different equations for adults (≥19 years of age, Chronic Kidney Disease-Epidemiology Collaboration equations for both creatinine and cystatin C) and children (<19 years of age, Schwartz and Larsson equations, for creatinine and cystatin C, respectively). Chronic kidney disease (CKD) was defined as an eGFR <90 mL/min/1.73 m2.Mean eGFR was 115.2 ± 23.9 by creatinine, and 113.6 ± 22.7 mL/min/1.73 m2 by cystatin C. CKD was identified in 16 individuals. Those with CKD as defined by cystatin C had a lower median platelet count (163 [115, 194] vs. 191 [153, 252] p = 0.048), had lower saturations (87.5% [85.3%, 94%] vs. 94% [91%, 95%], p = 0.006) and were more likely to have at least moderate atrioventricular valve regurgitation (31% vs. 7%, p = 0.01). While the same number of patients were classified as having CKD using creatinine-based equations, creatinine-based CKD was only associated with lower saturations (92% [85.3%, 93.8%] vs. 94% [91%, 95%], p = 0.02). Conclusions: Among individuals with a Fontan circulation, defining CKD based on cystatin C rather than creatinine appears to identify a group of patients with characteristics associated with increased risk for clinical deterioration.
format	article
author	David A. Katz Adam M. Lubert Zhiqian Gao Adam W. Powell Cassandra Szugye Shalayna Woodly Stuart L. Goldstein Tarek Alsaied Alexander R. Opotowsky
author_facet	David A. Katz Adam M. Lubert Zhiqian Gao Adam W. Powell Cassandra Szugye Shalayna Woodly Stuart L. Goldstein Tarek Alsaied Alexander R. Opotowsky
author_sort	David A. Katz
title	Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation
title_short	Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation
title_full	Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation
title_fullStr	Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation
title_full_unstemmed	Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation
title_sort	comparison of creatinine and cystatin c estimation of glomerular filtration rate in the fontan circulation
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/a584612bc4d14d51ab132644a5f146cc
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Comparison of creatinine and cystatin C estimation of glomerular filtration rate in the Fontan circulation

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