Performance of serum cystatin C versus serum creatinine as a marker of glomerular filtration rate as measured by inulin renal clearance

Clin Exp Nephrol. 2011 Dec;15(6):868-76. doi: 10.1007/s10157-011-0525-y. Epub 2011 Aug 24.


Introduction: Serum cystatin C was recently proposed as an alternative marker of glomerular filtration rate (GFR), with a suggested better performance than creatinine. However, detailed studies are limited. We evaluated the performance of cystatin C as a GFR marker.

Methods: GFR was measured by inulin clearance in 763 Japanese subjects. Factors other than GFR influencing serum cystatin C or serum creatinine were analyzed by multivariate analyses.

Results: After adjustment for GFR, the value of serum creatinine was 25.2% lower in females than males, and decreased by 5.2% for every 20 years of age. Serum cystatin C was 8.2% lower in females, and did not change significantly with aging. Creatinine but not cystatin C was significantly affected by body weight, height and body mass index after adjustment for GFR, gender and age. The correlation coefficient between GFR and 1/cystatin C was significantly higher than that of 1/creatinine in total subjects (0.866 and 0.810, respectively, p < 0.001). Unlike serum creatinine, serum cystatin C did not increase in association with the reduction of GFR in subjects with very low GFR. The regression line of 1/cystatin C against GFR showed a significantly negative intercept of about -8 ml/min/1.73 m(2).

Conclusion: The performance of serum cystatin C was not good in the subjects with very low GFR. Non-renal elimination of cystatin C may contribute to the result. The correlation between reciprocal cystatin C and GFR suggested its superiority in predicting GFR compared to creatinine in subjects with normal and mildly reduced GFR.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biomarkers / blood
  • Creatinine / blood*
  • Cystatin C / blood*
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Inulin*
  • Japan
  • Kidney / physiopathology*
  • Kidney Diseases / blood
  • Kidney Diseases / diagnosis*
  • Kidney Diseases / physiopathology
  • Linear Models
  • Male
  • Middle Aged
  • Models, Biological*
  • Multivariate Analysis
  • Predictive Value of Tests
  • Young Adult


  • Biomarkers
  • CST3 protein, human
  • Cystatin C
  • Inulin
  • Creatinine