Comparison of creatinine and cystatin C for estimation of glomerular filtration rate in pediatric patients after Fontan operation.
Biomarkers
/ blood
Child
Child, Preschool
Creatinine
/ blood
Cystatin C
/ blood
Female
Follow-Up Studies
Fontan Procedure
/ adverse effects
Glomerular Filtration Rate
/ physiology
Heart Defects, Congenital
/ surgery
Humans
Male
Postoperative Complications
Prognosis
Renal Insufficiency
/ blood
Retrospective Studies
Fontan
acute kidney injury
chronic kidney disease
cystatin C
Journal
Congenital heart disease
ISSN: 1747-0803
Titre abrégé: Congenit Heart Dis
Pays: United States
ID NLM: 101256510
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
06
02
2019
revised:
11
03
2019
accepted:
03
04
2019
pubmed:
18
4
2019
medline:
25
2
2020
entrez:
18
4
2019
Statut:
ppublish
Résumé
There are several limitations when using creatinine to estimate glomerular filtration rate, especially in children with chronic medical conditions who are at high risk of kidney dysfunction. Cystatin C has been the recent focus of research as a replacement biomarker for creatinine. Our objective was to compare the 2 biomarkers in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. We hypothesized that there would be poor correlation and agreement between the 2 estimates of renal function. This was a single center retrospective chart review of 20 patients who had previously undergone Fontan operation. Demographic and clinical data were collected from medical records. Blood samples were collected as part of routine clinical care and simultaneously measured for serum creatinine and cystatin C. Glomerular filtration rate was calculated using the creatinine-based bedside Schwartz formula and cystatin C-based Zapatelli equation. Spearman correlation and Bland-Altman analysis were used to assess correlation and agreement. The median Schwartz-derived estimated glomerular filtration rate was 98.94 mL/min/1.73 m The bedside Schwartz formula may be an overestimate of glomerular filtration rate in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. While larger studies are necessary, cystatin C is a promising biomarker to replace creatinine and better estimate kidney function in this population.
Sections du résumé
BACKGROUND
BACKGROUND
There are several limitations when using creatinine to estimate glomerular filtration rate, especially in children with chronic medical conditions who are at high risk of kidney dysfunction. Cystatin C has been the recent focus of research as a replacement biomarker for creatinine. Our objective was to compare the 2 biomarkers in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. We hypothesized that there would be poor correlation and agreement between the 2 estimates of renal function.
METHODS
METHODS
This was a single center retrospective chart review of 20 patients who had previously undergone Fontan operation. Demographic and clinical data were collected from medical records. Blood samples were collected as part of routine clinical care and simultaneously measured for serum creatinine and cystatin C. Glomerular filtration rate was calculated using the creatinine-based bedside Schwartz formula and cystatin C-based Zapatelli equation. Spearman correlation and Bland-Altman analysis were used to assess correlation and agreement.
RESULTS
RESULTS
The median Schwartz-derived estimated glomerular filtration rate was 98.94 mL/min/1.73 m
CONCLUSION
CONCLUSIONS
The bedside Schwartz formula may be an overestimate of glomerular filtration rate in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. While larger studies are necessary, cystatin C is a promising biomarker to replace creatinine and better estimate kidney function in this population.
Substances chimiques
Biomarkers
0
Cystatin C
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
760-764Subventions
Organisme : NIH K08 Career Development Award
Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Esch JJ, Salvin JM, Thiagarajan RR, Pedro J, Rajagopal SK. Acute kidney injury after Fontan completion: risk factors and outcomes. J Thorac Cardiovasc Surg. 2015;150(1):190-197.
Patterson T, Hehir DA, Buelow M, et al. Hemodynamic profile of acute kidney injury following the fontan procedure: impact of renal perfusion pressure. World J Pediatr Congenit Heart Surg. 2017;8(3):367-375.
Patel S, Kwiatkowski D, Andrei A, et al. Prevalence and risk factors associated with chronic kidney disease in patients with single ventricle congenital heart disease after fontan palliation. J Am Coll Cardiol. 2017;69(11 suppl): poster 586.
Bacchetta J, Cochat P, Rognant N, Ranchin B, Hadj-Aissa A, Dubourg L. Which creatinine and cystatin C equations can be reliably used in children? Clin J Am Soc Nephrol. 2011;6(3):552-560.
Coca SG, Yalavarthy R, Concato J, Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int. 2008;73(9):1008-1016.
Filler G, Bökenkamp A, Hofmann W, Le Bricon T, Martínez-Brú C, Grubb A. Cystatin C as a marker of glomerular filtration rate-history, indications, and future research. Clin Biochem. 2005;38(1):1-8.
Lee J, Hahn W, Ahn J, Chang J, Bae C. Serum cystatin C during 30 postnatal days is dependent on the postconceptional age in neonates. Pediatr Nephrol. 2013;28(7):1073-1078.
Abdelaal NA, Shalaby SA, Khashana AK, Abdelwahab AM. Serum cystatin C as an earlier predictor of acute kidney injury than serum creatinine in preterm neonates with respiratory distress syndrome. Saudi J Kidney Dis Transpl. 2017;28(5):1003-1014.
Ataei N, Bazargani B, Ameli S, et al. Early detection of acute kidney injury by serum cystatin C in critically ill children. Pediatr Nephrol. 2014;29(1):133-138.
Roos JF, Doust J, Tett SE, Kirkpatrick CM. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children-a meta-analysis. Clin Biochem. 2007;40(5-6):383-391.
Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002;40(2):221-226.
Fox JA, Dudley AG, Bates C, Cannon GM Jr. Cystatin C as a marker of early renal insufficiency in children with congenital neuropathic bladder. J Urol. 2014;191(5):1602-1607.
VITROS chemistry products CREA slides. Rochester, NY: Orthor-Clinical Diagnostics Inc; 2011.
Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4(11):1832-1843.
Zappitelli M, Parvex P, Joseph L, et al. Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis. 2006;48(2):221-230.
Pottel H, Dubourg L, Goffin K, Delanaye P. Alternatives for the bedside Schwartz equation to estimate glomerular filtration rate in children. Adv Chronic Kidney Dis. 2018;25(1):57-66.
Nehus EJ, Laskin BL, Kathman TI, Bissler JJ. Performance of cystatin C-based equations in a pediatric cohort at high risk of kidney injury. Pediatr Nephrol. 2013;28(3):453-461.
Shlipak MG, Matsushita K, Ärnlöv J, et al. Cystatin C versus creatinine in determining risk based on kidney function. N Engl J Med. 2013;369(10):932-943.
Avitabile CM, Leonard MB, Zemel BS, et al. Lean mass deficits, vitamin D status and exercise capacity in children and young adults after Fontan palliation. Heart. 2014;100(21):1702-1707.
Hasson DC, Brinton JT, Cowherd E, Soranno DE, Gist KM. Risk factors for recurrent acute kidney injury in children who undergo multiple cardiac surgeries: a retrospective analysis. Ped Crit Care Med. 2019.
Wilson TG, d'Udekem Y, Winlaw DS, et al. Hepatic and renal end-organ damage in the fontan circulation: a report from the australian and new zealand fontan registry. Int J Cardiol. 2018;273:100-107.
Sharma S, Ruebner RL, Furth SL, Dodds KM, Rychik J, Goldberg DJ. Assessment of kidney function in survivors following fontan palliation. Congenit Heart Dis. 2016;11(6):630-636.
Opotowsky AR, Baraona FR, Mc Causland FR, et al. Estimated glomerular filtration rate and urine biomarkers in patients with single-ventricle fontan circulation. Heart. 2017;103(6):434-442.