Pre-donation Assessment of Cystatin C to Improve Prediction of Pre- and Post-Donation GFR in Potential Living Kidney Donors

Jessica van der Weijden; Daan Kremer; Lisa B Westenberg; Jan-Stephan F Sanders; Robert A Pol; Ilja M Nolte; Martin H De Borst; Stefan P Berger; Stephan J L Bakker; Marco van Londen

doi:10.1093/ndt/gfae065

Pre-donation Assessment of Cystatin C to Improve Prediction of Pre- and Post-Donation GFR in Potential Living Kidney Donors

Nephrol Dial Transplant. 2024 Mar 13:gfae065. doi: 10.1093/ndt/gfae065. Online ahead of print.

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 38479785
DOI: 10.1093/ndt/gfae065

Abstract

Background and hypothesis: Accurate estimation of glomerular filtration rate (GFR) is crucial in living kidney donation. While most eGFR equations are based on plasma creatinine, its levels are strongly influenced by muscle mass. Application of cystatin C (CysC)-based estimates before donation may improve both estimation of current GFR and prediction of post-donation GFR.

Methods: We assessed the performance of CKD-EPI equations based on creatinine (eGFRcreat-2009, eGFRcreat-2021), cystatin C (eGFRCysC-2012), or both (eGFRcombined-2012, eGFRcombined-2021) for estimating pre- and post-donation measured GFR in 486 living kidney donors. We subsequently focused on a subgroup of individuals with high/low muscle mass (25% highest/lowest 24-hour urinary creatinine excretion, sex-stratified and height-indexed).

Results: Pre-donation eGFRcombined 2012 and eGFRcombined 2021 showed the strongest associations with pre- and post-donation mGFR. Pre-donation eGFRcombined 2021 was most accurate for estimating both pre-donation (bias 0.01±11.9 mL/min/1.73m2) and post-donation mGFR (bias 1.3±8.5 mL/min/1.73 m2). In donors with high/low muscle mass, CysC-based equations (with or without creatinine) performed better compared to equations based on only creatinine.

Conclusions: In conclusion, combined eGFR equations yielded a better estimate of pre- and post-donation mGFR, compared to estimates based on creatinine or CysC only. The added value of CysC seems particularly pronounced in donors with high or low muscle mass.

Keywords: cystatin C; glomerular filtration rate; living kidney donation; muscle mass; post-donation GFR.