Cystatin C as a biomarker of chronic kidney disease: latest developments

ABSTRACT

Introduction

Chronic kidney disease (CKD) is common, occurring in over 10% of individuals globally, and is increasing in prevalence. The limitations of traditional biomarkers of renal dysfunction, such as serum creatinine, have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as serum cystatin C, has the potential to improve disease monitoring and patient care.

Areas covered

The present paper assesses the utility and limitations of serum cystatin C as a biomarker for CKD in light of the current literature.

Expert opinion

Serum cystatin C has been well established as an early and accurate biomarker of CKD that is particularly helpful in patients for whom creatinine is an inadequate marker or for whom more cumbersome methods of glomerular filtration rate (GFR) measurement are impractical. Current research questions are no longer focused on if, but rather when and how often cystatin C should be used in the evaluation of CKD patients. However, transition of all reagents and estimated GFR equations to the newly established International Standard is critical for developing generalizable data.

KEYWORDS:

• Biomarkers
• chronic kidney disease
• cystatin C
• estimated glomerular filtration rate

Article highlights

• Serum cystatin C is an earlier and more accurate biomarker of GFR than creatinine in many patient populations.

• Cystatin C is independently associated with cardiovascular disease, end stage renal disease, and all-cause mortality.

• The new IFCC-calibrated reagent has made standardization of cystatin C values across clinical laboratories and the creation of universal GFR estimation equations possible.

• Clinical laboratories should strive to standardize their approach and broaden availability of this assay.

• The cost and long-term benefits of routine cystatin C monitoring and earlier diagnosis of renal impairment and cardiovascular risk with cystatin C is worth thoughtful prospective investigation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

PD is funded by grants from the National Institutes of Health (P50 DK096418).