Sunil Sethi

National University Health System, Singapore

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Publications (68)

  • Tze Ping Loh · Xiong Chang Lim · Karize Kieu · [...] · Sunil Kumar Sethi
    [Show abstract] [Hide abstract] ABSTRACT: Introduction This study aimed to examine the recovery of spiked human cardiac troponin I (cTnI) results measured by four routine assays, and investigate possible interference from microclots. Materials and methods 457 consecutive samples with cTnI concentration below limit of quantitation (12 ng/L), declared by the Vitros TnI ES assay (reference assay), were measured on Beckman Coulter Accu TnI+3, Siemens TnI-Ultra and Roche TnI STAT assays. These samples were enriched with native full-length cTnI to a concentration of 100 ng/L and retested. A post-spiking result that exceeded the critical difference at a predefined probability of 0.0005 of the target concentration (the median post-spiking result for each individual assay) was considered as outlier. To determine whether microclots were a significant cause of critically discrepant outlier results, a separate 50 samples were centrifuged twice between two post-spiking measurements using the Vitros TnI ES assay. Results The median recovery of the enriched cTnI was highest with the Roche assay (271 ng/L) and lowest with the Vitros assay (29 ng/L). The Vitros assay had the highest percentage of results that exceeded the critical difference (49%), followed by the Siemens (38%), Roche (18%) and Beckman Coulter (7%) assays. None of the 50 additional samples produced a critically lower cTnI result after re-centrifugation. Conclusions Our findings underscored the variability of cTnI assays in measuring native cTnI. The lack of cTnI results that became significantly lower after re-centrifugation suggested that microclots are unlikely to be a major cause of the outlier results.
    Article · Jun 2016 · Biochemia Medica
  • BW Teo · HR Chua · WK Wong · [...] · T Lau
    [Show abstract] [Hide abstract] ABSTRACT: INTRODUCTION Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD. METHODS Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses. RESULTS 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m2. At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020). CONCLUSION Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients.
    Article · May 2016 · Singapore medical journal
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Serum cystatin C, a novel marker of renal function has been shown to be superior to serum creatinine in predicting renal function decline and adverse outcomes of chronic kidney disease (CKD). Our aim was to investigate the association between cystatin C and retinopathy in adults without diabetes. Methods: We examined 1725 Indian adults, aged 40-80 years who participated in the Singapore Indian Eye Study (2007-2009) and were free of diabetes mellitus. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) determined from serum cystatin C (CKD-eGFRcys, n = 199), and serum creatinine (CKD-eGFRcr, n = 81). Retinopathy was assessed from digital fundus photographs of both eyes by trained graders using the modified Airlie House classification. The associations of CKD defined by the two markers alone and in combination (confirmed CKD, eGFRcr <60 and eGFRcys <60, n = 58) with retinopathy were examined using logistic regression models adjusted for potential confounding factors including preexisting cardiovascular disease and albuminuria. Results: The prevalence of retinopathy among those with CKD-eGFRcr and CKD-eGFRcys was 9.9% and 8.5%, respectively. In separate models, the associations of retinopathy with both CKD-eGFRcys (odds ratio (OR) (95% confidence interval (CI)) = 2.18 (1.14-4.16)) and CKD-eGFRcr were significant (OR (95% CI) = 2.63 (1.10-6.28)). In models including both markers, compared to optimal kidney function (eGFRcr ≥60 and eGFRcys ≥60), confirmed CKD was associated with a fourfold higher odds of retinopathy (OR (95% CI) = 4.01 (1.52-10.60)). Conclusions: In a population-based sample of Indian adults without diabetes, CKD defined by both cystatin C and creatinine was strongly associated with retinopathy.
    Article · Feb 2016 · European Journal of Preventive Cardiology
  • Article · Jan 2016 · Endocrine
  • Article · Dec 2015 · Wiener klinische Wochenschrift
  • Article · Sep 2015 · Clinical Chemistry and Laboratory Medicine
  • Tze Ping Loh · Sunil K Sethi
    [Show abstract] [Hide abstract] ABSTRACT: To describe a multidisciplinary effort to investigate and reduce the occurence of outpatient spurious hyperkalaemia. Spurious hyperkalemia is a falsely elevated serum potassium result that does not reflect the in vivo condition of a person. A common practice of fist clenching/pumping during phlebotomy to improve vein visualisation is an under-appreciated cause of spurious hyperkalemia. Pre- and postinterventional study. Objective evidence of spurious hyperkalaemia was sought by reviewing archived laboratory results. A literature review was undertaken to summarise known causes of spurious hyperkalaemia and develop a best practice in phlebotomy. Subsequently, nurses from the Urology Clinic were interviewed, observed and surveyed to understand their phlebotomy workflow and identify potential areas of improvement by comparing to the best practice in phlebotomy. Unexplained (potentially spurious) hyperkalaemia was defined as a serum potassium of >5·0 mmol/l in a patient without stage 5 chronic kidney disease or haemolysed blood sample. Nurses from the Urology Clinic showed significant knowledge gap regarding causes of spurious hyperkalaemia when compared to the literature review. Direct observation revealed patients were routinely asked to clench their fists, which may cause spurious hyperkalaemia. Following these observations, several educational initiatives were administered to address the knowledge gap and stop fist clenching. The rate of unexplained hyperkalaemia at the Urology clinic reduced from a baseline of 16·0-3·8%, 58 weeks after intervention. Similar education intervention was propagated to all 18 other specialist outpatient clinic locations, which saw their rate of unexplained hyperkalaemia decrease from 5·4 to 3·7%. To ensure sustainability of the improvements, the existing phlebotomy standard operating protocol, educational and competency testing materials at variance with the best practice were revised. A simple intervention of avoiding fist clenching/pumping during phlebotomy produced significant reduction in the rate of spurious hyperkalemia. © 2015 John Wiley & Sons Ltd.
    Article · Jul 2015 · Journal of Clinical Nursing
  • Boon Wee Teo · Peh Joo Ho · Titus Lau · Sunil Sethi
    [Show abstract] [Hide abstract] ABSTRACT: Background: The most important therapeutic step in the general retardation of chronic kidney disease (CKD) progression is the control of blood pressure (BP). Objective: We examined the impact of age on antihypertensive medication usage in a population of multi-ethnic Asians with stable CKD. Methods: We prospectively recruited 613 stable CKD outpatients. Patients were classified by age >65 and <65 years. Different classes of antihypertensives were analyzed by age categories using Chi-square test. Results: There were 613 patients (male 55.1%, Chinese 74.7%, Indian 6.4%, Malay 11.4%, Others 7.5%) with mean age 57.8 +/- 14.5 years (191 age >65). Patients with a history of diabetes were 35.7%, and diagnosed hypertension was 69%. Mean systolic BP was 139 +/- 21 mmHg, diastolic BP 74 +/- 11 mmHg, serum creatinine 166 +/- 115 [mu]mol/L, and GFR 53 +/- 32 mL/min/1.73 m2. Renin-angiotensin-aldosterone-system blockers were the most commonly prescribed antihypertensives (391/1136). More patients with diabetes were on an ACE-I or ARB (69.9% vs. 60.4%; p = 0.0225); and more patients diagnosed with diabetic CKD were on an ACE-I or ARB (142/204, 69.6% vs. 249/409, 60.9%, p = 0.0401). More patients aged >65 years were on 3 or more antihypertensives (46.1% vs. 22.5%). They were more likely to be on a diuretic (45.6% vs. 29.4%, p < 0.001), beta-blocker (19.6% vs. 14.2%, p < 0.001), dihydropyridine-calcium channel blockers (67.5% vs. 37.2%, p < 0.001), and alpha-blockers (6.8% vs. 1.4%, p < 0.001). Usage of ACE-I or ARB and non-dihydropyridine-calcium channel blocker were not different by age groups. Conclusions: Elderly Asian CKD patients use more antihypertensives. Copyright
    Article · Jun 2015 · Journal of Hypertension
  • Tze Ping Loh · Sunil Kumar Sethi · Michael Patrick Metz
    [Show abstract] [Hide abstract] ABSTRACT: To describe the reference intervals and biological variation data for thyrotropin (TSH) and free thyroxine (FT4) in a mixed Asian population using an indirect sampling approach and to compare them with published reports. TSH and FT4 of children measured once or twice over a 7-year period (2008-2014) at primary-care and tertiary-care settings were extracted from the laboratory information system. After excluding outliers, age-related reference intervals were derived using the Lambda-Mu-Sigma (LMS) approach, while age-partitioned biological variation data were obtained according to recommendations by Fraser and Harris. Both TSH and FT4 were very high at birth and declined with age. Similarly within-individual and between-individual biological variations were higher for both TSH and FT4 at birth and also declined with age. Our data were broadly similar to previous studies. Significant heterogeneity in study population and methods prohibited direct numerical comparison between this and previously published studies. This study fills two important gaps in our knowledge of paediatric thyroid function by reporting the centile trends (and reference values) in a mixed Asian population, as well as providing age-partitioned biological variation data. The variation in published reference intervals highlights the difficulty in harmonising paediatric thyroid reference intervals or recommending universal clinical cut-offs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Article · Apr 2015 · Journal of clinical pathology
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    [Show abstract] [Hide abstract] ABSTRACT: Adiponectin and leptin, two of the key cytokines secreted by adipocytes, have been shown to be associated with cardiovascular disease. However, the association of these adipocytokines with chronic kidney disease (CKD) is not clear. We examined the association of serum adiponectin, leptin levels and leptin to adiponectin ratio (LAR) with CKD in a population-based sample of Asian adults. We conducted a case-control study (450 CKD cases and 920 controls matched for age, sex and ethnicity) involving Chinese and Indian adults aged 40-80 years who participated in the Singapore Epidemiology of Eye Diseases Study (2007-2011). CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73m2 from serum creatinine. Serum adiponectin and leptin levels were measured using commercially available ELISA. Odds ratio of CKD associated with elevated adiponectin and leptin levels were estimated using logistic regression models adjusted for age, gender, ethnicity, education, smoking, body mass index, diabetes, blood pressure, total and HDL cholesterol. CKD cases had higher levels of leptin (mean [SD] 9.7 [11.5] vs.16.9 [20.2] ng/mL, p<0.0001) and adiponectin (10.4 [7.4] vs. 9.2 [4.2], p = 0.001) compared to controls. In multi-variable models, compared to those in the lowest quartile, the OR (95% confidence interval) of CKD among those in the highest quartile were: 6.46 (3.84, 10.88), 1.94 (1.32-2.85) and 2.88 (1.78-4.64) for leptin, adiponectin and LAR. Similar associations were also observed when adiponectin and leptin were analyzed as continuous variables. This positive association of serum adiponectin, leptin and LAR with CKD was consistently present in subgroups of gender, ethnicity, diabetes, hypertension and overweight status (all P-interaction >0.1). Higher levels of serum adiponectin, leptin and LAR were positively associated with CKD independent of traditional risk factors in this Asian population.
    Full-text Article · Mar 2015 · PLoS ONE
  • Tze Ping Loh · Sunil Kumar Sethi · Moh Sim Wong · [...] · Shih Ling Kao
    [Show abstract] [Hide abstract] ABSTRACT: The relationship between glycated hemoglobin A1c (HbA1c) and average glucose has been described by the empirically derived estimated average glucose (eAG) equation in the A1c-derived Average Glucose (ADAG) study, with extensive calibration efforts in four secondary reference HbA1c methods. It is not known if this relationship is preserved when HbA1c is measured by routine laboratory methods under routine conditions. We measured average glucose (mAG) by six days of continuous glucose monitoring in 45 adults with stable HbA1c (<1% HbA1c change in the preceding two months). Subjects with medical conditions that may confound HbA1c measurement, including anemia and hemoglobinopathy, were excluded. HbA1c were measured using Bio-Rad Variant II (cation-exchange HPLC), Bio-Rad in2it (boronate affinity HPLC) and Roche Tina-quant (immunoassay) methods. The average differences between eAG derived from the routine HbA1c methods and mAG were 10.4% (Variant II), 6.0% (Tina-quant) and 1.0% (in2it). The regression coefficients between the mAG and HbA1c are different between in2it (mAG, mmol/L = 0.58×%HbA1c + 2.3), Tina-quant and Variant II (both mAG, mmol/L = 0.66×%HbA1c + 1.9). However, the 95% confidence intervals of the slope and bias of these methods overlap. The correlation between mAG and HbA1c was greatest when measured using the Variant II (r(2)=0.84), followed by Tina-quant (r(2)=0.82) and in2it (r(2)=0.71). The relationship between HbA1c and measured average glucose is method-dependent despite improved HbA1c standardization. The differences in relationship may reflect as discrepant eAG and home glucose monitoring results. Copyright © 2015. Published by Elsevier Inc.
    Article · Mar 2015 · Clinical Biochemistry
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose:Leptin, a 167-aminoacid protein secreted by adipocytes has been shown to reduce beta-amyloid deposition and intracellular lipid concentration in animal models, two key pathogenic mechanisms underlying aging. We examined the association between serum leptin levels and age-related macular degeneration (AMD). Methods: We conducted a population-based case-control study including Chinese and Indian adults aged 40-80 years who participated in the Singapore Epidemiology of Eye Diseases Study (2007-2011). AMD was assessed from retinal photographs graded using a modified Wisconsin Age-Related Maculopathy Grading System (n=423, early = 387, late=36). Controls (n=927) without AMD were frequency matched for age, gender and ethnicity. Serum leptin levels were measured using direct sandwich ELISA. Results:Participants with AMD had lower levels of leptin compared to those without (mean (SD) = 10.0 (11.5) vs. 12.9 (16.4) ng/mL; p=0.001). Mean levels of leptin among those with late, early and without AMD were 8.8, 10.1 and 12.9 (p-trend= 0.005). In multivariable models adjusting for potential confounders including smoking, body mass index, blood pressure and HDL cholesterol, increasing quartiles of leptin were associated with lower odds of AMD, odds ratio (95% confidence interval) of AMD was 0.56 (0.34-0.92) comparing highest to lowest quartile of serum leptin. In subgroup analyses, the inverse association between leptin and AMD was significant in women, Indian ethnicity and ex-smokers (all P-interaction>0.05). Conclusions:Higher serum leptin levels were inversely associated with AMD. These findings, if confirmed in prospective studies, may provide insights into new pathogenic pathways and possibly therapeutic targets in AMD. Copyright © 2015 by Association for Research in Vision and Ophthalmology.
    Article · Feb 2015 · Investigative Ophthalmology & Visual Science
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    [Show abstract] [Hide abstract] ABSTRACT: Vitamin D levels are linked to susceptibility to infections, but its relevance in candidaemia is unknown. We aimed to investigate the in-vivo sequelae of vitamin D3 supplementation in systemic Candida infection. Implicating the role of vitamin D in Candida infections, we showed that candidemia patients had significantly lower 25-OHD concentrations. Candida-infected mice treated with low dose 1,25(OH)2D3 had reduced fungal burden and better survival relative to untreated mice. Conversely, higher 1,25(OH)2D3 doses led to poor outcomes. Mechanistically, low dose 1,25(OH)2D3 induced proinflammatory immune responses. This was mediated through suppression of SOCS3 and induction of VDR binding with the vitamin D response elements in the IFN-γ promoter. These beneficial effects were negated with higher vitamin D(3) doses. While the anti-inflammatory effects of vitamin D3 are well-described, we found that lower doses conversely conferred proinflammatory benefits in Candida infection. Our study highlights caution against extreme deviations of vitamin D levels in infections. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:
    Full-text Article · Jan 2015 · The Journal of Infectious Diseases
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    [Show abstract] [Hide abstract] ABSTRACT: Purpose. We examined the association of CKD defined by serum creatinine, serum cystatin C, and albuminuria with moderate diabetic retinopathy (DR). Methods. We examined 1,119 Indian adults with diabetes, aged 40–80 years, who participated in the Singapore Indian Eye Study (2007–2009), a population-based cross-sectional study. The associations of CKD defined by each of the three markers alone and in combination with moderate DR were examined using logistic regression models adjusted for potential confounding factors including duration of diabetes, smoking, body mass index, systolic blood pressure, and HbA1c. Results. The prevalence of moderate DR was significantly higher among those with CKD defined by triple markers (41.1%) compared to CKD defined separately by creatinine (26.6%), cystatin C (20.9%), and albuminuria (23.4%). People with CKD defined by triple markers had a fourteenfold higher odds of moderate DR (OR (95% CI) = 13.63 (6.08–30.54)) compared to those without CKD by any marker. Nearly half (48.7%) of participants with cystatin C ≥ 1.12 mg/L have moderate DR. Conclusions. CKD defined by a triple marker panel was strongly associated with moderate DR in this Asian population with diabetes.
    Full-text Article · Jan 2015 · Journal of Diabetes Research
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    [Show abstract] [Hide abstract] ABSTRACT: Background. The use of spot urine protein to creatinine ratios in estimating 24 hr urine protein excretion rates for diagnosing and managing chronic kidney disease (CKD) predated the standardization of creatinine assays. The comparative predictive performance of spot urine ratios and 24 hr urine collections (of albumin or protein) for the clinical outcomes of CKD progression, end-stage renal disease (ESRD), and mortality in Asians is unclear. We compared 4 methods of assessing urine protein excretion in a multiethnic population of CKD patients. Methods. Patients with CKD ( n = 232 ) provided 24 hr urine collections followed by spot urine samples the next morning. We created multiple linear regression models to assess the factors associated with GFR decline (median follow-up: 37 months, IQR 26–41) and constructed Cox proportional-hazards models for predicting the combined outcome of ESRD and death. Results. The linear regression models showed that 24 hr urine protein excretion was most predictive of GFR decline but all other methods were similar. For the combined outcomes of ESRD and death, the proportional hazards models had similar predictive performance. Conclusions. We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research.
    Full-text Article · Jan 2015 · International Journal of Nephrology
  • Boon Wee Teo · Titus Lau · Qi Chun Toh · [...] · Sunil Sethi
    Article · Dec 2014 · Clinical Chemistry and Laboratory Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: Clinical practice guidelines recommend using creatinine-based equations to estimate glomerular filtration rates (GFRs). While these equations were formulated for Caucasian-American populations and have adjustment coefficients for African-American populations, they are not validated for other ethnicities. The Chronic Kidney Disease-Epidemiology Collaborative Group (CKD-EPI) recently developed a new equation that uses both creatinine and cystatin C. We aimed to assess the accuracy of this equation in estimating the GFRs of participants (healthy and with chronic kidney disease [CKD]) from a multiethnic Asian population. Serum samples from the Asian Kidney Disease Study and the Singapore Kidney Function Study were used. GFR was measured using plasma clearance of 99mTc-DTPA. GFR was estimated using the CKD-EPI equations. The performance of GFR estimation equations were examined using median and interquartile range values, and the percentage difference from the measured GFR. The study comprised 335 participants (69.3% with CKD; 38.5% Chinese, 29.6% Malays, 23.6% Indians, 8.3% others), with a mean age of 53.5 ± 15.1 years. Mean standardised serum creatinine was 127 ± 86 μmol/L, while mean standardised serum cystatin C and mean measured GFR were 1.43 ± 0.74 mg/L and 67 ± 33 mL/min/1.73 m2, respectively. The creatinine-cystatin C CKD-EPI equation performed the best, with an estimated GFR of 67 ± 35 mL/min/1.73 m2. The new creatinine-cystatin C equation estimated GFR with little bias, and had increased precision and accuracy in our multiethnic Asian population. This two-biomarker equation may increase the accuracy of population studies on CKD, without the need to consider ethnicity.
    Article · Dec 2014 · Singapore medical journal
  • Tze Ping Loh · Weng Kung Peng · Lan Chen · Sunil Kumar Sethi
    [Show abstract] [Hide abstract] ABSTRACT: Aims: We aim to develop smoothed continuous 2.5th and 97.5th percentile values for labile glycated haemoglobin A1c to glycated haemoglobin A1c (LHbA1c:HbA1c) ratio against HbA1c, and apply them on our patient population for identification of potentially spurious HbA1c measurements. Methods: The LHbA1c and HbA1c were measured using Bio-rad Variant II high-performance liquid chromatography system. We recorded the LHbA1c and HbA1c values of 1555 patients who had normal chromatograms. Using these results, the 2.5th and 97.5th percentile reference limits of the LHbA1c:HbA1c ratio were described by LHbA1c:HbA1c=-0.0072×HbA1c +0.2925 and LHbA1c:HbA1c=-0.0132×HbA1c +0.5327, respectively. Results: When the reference intervals were applied on a separate 1000 patients, 34 and 29 of them had abnormally high and low LHbA1c:HbA1c ratios, respectively. Most of the observed high ratios were associated concurrently with elevated plasma glucose, anaemia, chronic liver and kidney diseases. A suppressed ratio was mostly associated with haemoglobin variants. Patients with heterozygous HbE or HbS variants tend to have lower LHbA1c:HbA1c ratios while the converse is true for heterozygous HbJ. Conclusions: The continuous LHbA1c:HbA1c ratio may be used to detect confounding factors or spurious HbA1c results, but its performance is confounded and reduced by the ambient plasma glucose.
    Article · Jun 2014 · Journal of Clinical Pathology
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    Boon Wee Teo · Charumathi Sabanayagam · Jiemin Liao · [...] · Sunil Sethi
    [Show abstract] [Hide abstract] ABSTRACT: Background. Chronic kidney disease (CKD) is identified in the general population using estimated glomerular filtration rates (eGFR) calculated from a serum creatinine-based equation, the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation. Using serum cystatin C in combination may improve eGFR accuracy. We evaluated the new CKD-EPI equations incorporating cystatin C in a population of Asian Indians in classifying CKD across body mass index, diabetes, and hypertension status. Methods. We retrieved standardized serum creatinine and serum cystatin C data from a cohort of 2877 Asian Indians aged 40-80 years from the Singapore Indian Eye Study and calculated eGFR (in mL/min/1.73 m(2)) with the new CKD-EPI equations and serum creatinine only equation. Results. The creatinine only equation mean eGFR (88 ± 17) was similar to using spline Log cystatin C (88 ± 22). The lowest mean eGFR (81 ± 21) was obtained with the spline Log cystatin C-age, sex, and weight equation. The creatinine only equation had the fewest participants (7.1%) with eGFR <60 and spline Log cystatin C-age, sex, and weight equation had the most (16.1%). Conclusions. Using serum cystatin C resulted in widely varying eGFR which significantly affected the classification of chronic kidney disease.
    Full-text Article · Apr 2014 · International Journal of Nephrology
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    Karen Tan · Sunil K Sethi
    [Show abstract] [Hide abstract] ABSTRACT: Cardiac and renal diseases often coexist and patients with cardiac and renal failure have high morbidity and mortality. Cardiorenal syndromes (CRSs) are disorders of the heart and kidneys whereby dysfunction in one organ may induce dysfunction in the other organ. Five subtypes of CRSs have been defined by the Acute Dialysis Quality Initiative Consensus Group. There is a need for early detection and monitoring of patients with CRSs. Biomarkers play a key role in the diagnosis and monitoring of acute myocardial infarction, chronic heart failure, and chronic kidney disease. In recent years, new biomarkers have been identified that may play a role in the early diagnosis of acute kidney injury. Herein, we review the use of serum and urine biomarkers in the diagnosis and management of CRSs. The established cardiac and renal biomarkers such as the cardiac troponins, natriuretic peptides, urine albumin, and creatinine, as well as the new renal biomarkers cystatin C and neutrophil gelatinase-associated lipocalin are reviewed in detail. The recent advances in assay methods, clinical studies, and recommendations in clinical guidelines are discussed. With advances in biomarker research, in future, perhaps a multimarker approach will become feasible to stratify the diagnosis of CRS for individualized treatment and prognosis.
    Full-text Article · Apr 2014