Age, Gender, and Race Effects on Cystatin C Levels in US Adolescents

Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Clinical Journal of the American Society of Nephrology (Impact Factor: 4.61). 10/2008; 3(6):1777-85. DOI: 10.2215/CJN.00840208
Source: PubMed


The objective of this study was to describe the normal range of serum cystatin C and identify factors associated with variability in serum cystatin C contrasting with factors that are known to influence creatinine levels in the general US adolescent population.
Serum cystatin C and creatinine were measured in 719 participants aged 12 to 19 yr in the Third National Health and Nutrition Examination Survey, a national cross-sectional survey conducted in 1988 through 1994. We calculated gender- and race/ethnicity-specific cystatin C and creatinine ranges and conducted multivariable linear regression analyses to assess factors that contribute to variability in cystatin C and creatinine levels.
Overall, the mean serum cystatin C level was 0.84 mg/L and was higher in male than female individuals and higher in non-Hispanic white versus non-Hispanic black and Mexican American individuals. The mean serum creatinine was 0.71 mg/dl and was higher in male than in female individuals but lower in non-Hispanic white and Mexican American compared with non-Hispanic black individuals. Unlike creatinine, which increases with age from 12 to 19 yr, cystatin C levels decrease, particularly in female individuals. After adjustment for age, gender, and race/ethnicity, uric acid and blood urea nitrogen were significantly associated with cystatin C levels.
Serum cystatin C is significantly related to gender, age, race/ethnicity, uric acid, and blood urea nitrogen in adolescents.

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    • "However, serum creatinine can be affected by age, gender, ethnicity, dietary protein intake, and muscle mass, and its measurement requires a variety of analytical interferences and is associated with significant standardization problems [1,6,7,8,9,10,23,24]. In contrast, although the notion that the capacity of cystatin C to predict GFR is not influenced by body composition has been controversial, several studies have reported that the use of cystatin C has the advantages of being less influenced by age, gender, weight, and muscle mass compared to the use of serum creatinine [11,12,13,14,15,25]. Therefore, some new cystatin C formulas have been developed and compared with the corresponding formulas for creatinine [15,26,27,28]. "
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    ABSTRACT: Background Accurate renal function measurements are important in the diagnosis and treatment of kidney diseases. In contrast to creatinine, the production of serum cystatin C has been extensively reported to be unaffected by body muscle mass, age, gender, and nutritional status. Methods Our study included 37 samples from diabetic chronic kidney disease (CKD) patients for whom serum creatinine tests had been requested and 40 samples from a healthy populations in Dong-A University Hospital between May 2010 and June 2010. The assay precision (i.e., the coefficient of variation) and the reference range of the serum cystatin C test were evaluated. We compared the estimated glomerular filtration rates (GFRs) based on cystatin C with those based on creatinine. Moreover, we investigated the influences of age, gender, weight, and muscle mass on serum creatinine and serum cystatin C. Results There was a positive correlation between GFR based on creatinine and that based on cystatin C (r=0.79, P<0.0001) among the diabetic CKD patients. Serum creatinine and cystatin C were significantly correlated with body weight and muscle mass, but the strengths of these correlations were greater for serum creatinine. The precision study revealed excellent results for both the high and low controls. The 95% reference interval of cystatin C in the healthy population was 0.371 to 1.236 mg/L. Conclusion Based on these results, we conclude that, despite the strong correlation between serum creatinine and cystatin C, cystatin C is less affected by weight and muscle mass and might represent a better alternative for the assessment of renal function.
    Full-text · Article · Aug 2014 · Diabetes & metabolism journal
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    • "These include for example the thyroid function or the administration of glucocorticosteroids,. The mean reference serum cystatin C level is 0.84 mg/L in non-Hispanic adolescents and normal renal function [5]. It is not known how ultrafiltration during extracorporeal circulation affects serum CysC levels [6]. "
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    ABSTRACT: Acute kidney injury (AKI) after cardiac surgery procedures is associated with poor patient outcomes. Cystatin C as a marker for renal failure has been shown to be of prognostic value; however, a wide range of its predictive accuracy has been reported. The aim of the study was to evaluate whether the measurement of pre- and postoperative serum cystatin C improves the prediction of AKI. In a single-centre, prospective study of 70 patients (74 +/- 9ys; range 47-85ys; 77% male), cystatin C was measured six times: (T1 = preoperative, T2 = start cardiopulmonary bypass (CPB), T3 = 20 min after CPB, T4 = end of operation; T5 = 24 h postoperatively; T6 = 7d postoperatively). Predictive property, in terms of the need for renal replacement therapy (RRT), was analysed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC). With respect to RRT (n = 8), serum cystatin C was significantly higher at the end of the operation (T4), 24 h postoperatively at T5 and at T6. The AUCs for preoperative T1 and intraoperative T2/3 cystatin C were <0.7 (95% CI, 0.47-0.85). The earliest significant predictive AUCs were found at the end of the operation (T4: p = 0.03 95%CI 0.58-0.88 AUC 0.73) and 24 h postoperatively (T5: p = 0.003 95%CI 0.74-0.96 AUC 0.85). Early postoperative serum cystatin C increase appears to be a moderate biomarker in the prediction of AKI, whereas a preoperative and intraoperative cystatin C increase has only a limited diagnostic and predictive value.
    Full-text · Article · Jan 2014 · Journal of Cardiothoracic Surgery
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    • "In the NHANES study, CysC levels were found to peak at the age of 12 in females, and at the age of 14 in males, apparently in the absence of changes in the GFR. Since CysC levels rose in parallel with peak height velocity, the authors proposed that CysC levels could be affected by growth in adolescents, and that the age-related variation in CysC levels was likely related to variation in CysC production [24]. "
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    ABSTRACT: Cystatin C (CysC) is an alternative marker to creatinine for estimation of the glomerular filtration rate (GFR). Hormones such as thyroid hormones and glucocorticoids are known to have an impact on CysC. In this study, we examined the effect of growth hormone (GH) on CysC in patients with acromegaly undergoing transsphenoidal surgery. Creatinine, CysC, GH and insulin-like growth factor-1 (IGF-1) were determined in 24 patients with acromegaly before and following transsphenoidal surgery. Estimated GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. In all patients, surgical debulking resulted in decreased clinical disease activity and declining GH/IGF-1 levels. Postoperatively, biochemical cure was documented in 20 out of 24 patients. Creatinine levels (mean ± SEM) increased from 72 ± 3 to 80 ± 3 µmol/l (p = 0.0004) and concurrently, estimated GFR decreased from 99 ± 3 to 91 ± 3 ml/min (p = 0.0008). In contrast to creatinine, CysC levels decreased from 0.72 ± 0.02 to 0.68 ± 0.02 mg/l (p = 0.0008). Our study provides strong evidence for discordant effects of GH on creatinine and CysC in patients with acromegaly undergoing transsphenoidal surgery, thus identifying another hormone that influences CysC independent of renal function.
    Full-text · Article · Nov 2013
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