Accuracy of cystatin C-based estimates of glomerular filtration rate in kidney transplant recipients: a systematic review

Nephrol Dial Transplant. 2013 Mar;28(3):741-57. doi: 10.1093/ndt/gfs498. Epub 2012 Dec 28.


Background: As with creatinine, cystatin C can be incorporated into a formula to estimate the glomerular filtration rate (GFR). The overall performance of cystatin C-based equations in kidney transplantation is unclear with conflicting results between studies.

Methods: Systematic review of adult kidney transplant recipients. Studies that reported mean bias (mean difference between the measured and estimated GFRs) or accuracy of the cystatin C-based GFR estimation equation (e.g. percentage of estimates within 30% of the measured GFR) against the measured GFR using renal or plasma clearance of contrast agents, radioisotopes or inulin were included.

Results: The search identified 10 studies that examined 14 different cystatin C-based estimating equations (n = 5 equations evaluated in more than one study). The Le Bricon equation had the best performance with a bias that ranged from -6.4 to +2.8 mL/min/1.73 m(2); 85% (95% CI, 82-88) of estimates were within 30% of the measured GFR. For the other equations, 66-82% of estimates were within 30% of the measured GFR. For the modification of diet in renal disease (MDRD) equation, 68% (95% CI, 65-72) of estimates were within 30% of the measured GFR.

Conclusions: The cystatin C-based Le Bricon equation was the most accurate, and most of the cystatin C-based equations showed improvements in 30% and 50% accuracy compared with the creatinine-based MDRD equation. Cystatin C-based equations may offer an advantage over the MDRD equation in kidney transplant recipients. Estimating equations re-expressed with standardized cystatin C have been developed and their accuracy needs to be tested in the kidney transplant population.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Biomarkers / analysis*
  • Cystatin C / analysis*
  • Glomerular Filtration Rate*
  • Humans
  • Kidney Transplantation*
  • Prognosis
  • Renal Insufficiency, Chronic / therapy*


  • Biomarkers
  • Cystatin C