geoffrey modest medical blogs

  A new meta-analysis confirmed the rather common finding of significant discordance between estimated GFR (eGFR) by cystatin vs creatinine, finding that when eGFR was significantly lower by cystatin, there were significant increases in all-cause mortality, cardiovascular events, and kidney failure (see  ckd cystatin better than creat JAMA2025  in dropbox, or doi:10.1001/jama.2025.17578)   Details : -- the data source for this meta-analysis was the Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC), focusing on participants with concurrent Cystatin-C (referred to as cystatin below) and creatinine measurements (eGFRcys and eGFRcr, respectively) and clinical outcomes, using an individual-level meta-analysis -- 23 outpatient cohorts: total of 821327 individuals     -- mean age 59, 48% female, 13.5% with diabetes, 40% with hypertension     -- mean eGFRcr 87, mean eGFRcys 81, median eGFRcys-eGFRcr difference of -5.4%, me...

  I am aware of the fact that I have done many blogs on cystatin C, perhaps too many. But, it seems to me that having as accurate a measure of estimated GFR is really important in terms of patient care, since so many issues depend on that, including the potential accuracy of medication-dosing based on renal function, as well as the treatment of the renal insufficiency itself. In that light, I herewith present the latest evaluation, this one finding that incorporating Cystatin C into the calculation of eGFR in older patients improved the prediction for all-cause mortality, the necessity for renal replacement therapy, as well as 6 other clinically important outcomes ( see  ckd  cystatin  c better in older pts AIM2024  in dropbox, or doi:10.7326/M23-1138 ).   Details: -- 82,154 people at least 65 years old who had outpatient creatinine and cystatin C measurements in this Swedish study, with information from 2010-2019    -- the SCR...