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Relationship of Serum Cystatin C to Peritoneal and Renal Clearance Measures in Peritoneal Dialysis: A Cross-sectional Study

American Journal of Kidney Diseases, ISSN: 0272-6386, Vol: 51, Issue: 2, Page: 278-284
2008
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Article Description

Clinical management of peritoneal dialysis patients includes assessments of peritoneal and renal clearances of the low-molecular-weight endogenous solutes creatinine and urea. Cystatin C is a low-molecular-weight protein used as a glomerular filtration rate marker. We investigated whether serum cystatin C concentration is related to peritoneal and renal clearances of creatinine and urea. Cross-sectional study. 119 patients undergoing peritoneal dialysis in a single dialysis unit. Peritoneal, renal, and total clearance of urea as Kt/V urea and creatinine as weekly creatinine clearance (C Cr ). Residual renal function (RRF) as the average of renal clearances of urea and creatinine. Serum concentrations of cystatin C measured by using a particle-enhanced nephelometric immunoassay. Serum cystatin C concentration was related inversely to RRF (Spearman rank correlation coefficient [ r s ] = −0.65; P < 0.001), total weekly C Cr ( r s = −0.52; P < 0.001), and total Kt/V urea ( r s = −0.23; P = 0.01). In a multiple regression model, weight, normalized protein catabolic rate, and RRF had independent effects on serum cystatin C concentrations. Additional multiple regression models showed that only the renal components of Kt/V urea and weekly C Cr contributed to serum cystatin C concentrations. Absence of reference GFR method. Serum cystatin C concentrations reflect predominantly renal, not peritoneal, clearance. Serum cystatin C measurement may be a simple and practical alternative to measurement of RRF.

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