Estimation of kidney function in patients with primary neuromuscular diseases: is serum cystatin C a better marker of kidney function than creatinine?

Background Using serum creatinine leads to an overestimation of kidney function in patients with primary neuromuscular disorders, and reduced kidney function may remain undetected. Cystatin C (CysC) could provide a better estimation. Aim To evaluate the precision, accuracy, and bias of two creatinine-, one cystatin C-based and one combined equation to estimate glomerular filtration rate (eGFR) in patients with primary neuromuscular disease. Patients and methods Of the 418 patients initially identified at the out-patient clinic, data on kidney function was obtained for 145 adult patients (age 46 +/- 14 years, BMI 26 +/- 6 kg/m(2)) with primary neuromuscular disease. Kidney function was measured by iohexol clearance, and blood samples for serum creatinine and CysC were drawn simultaneously. Bias was defined as the mean difference between eGFR and measured iohexol clearance, and accuracy as the proportion of eGFRs within +/- 10% (P10) of measured clearance. Results Kidney function (iohexol clearance) was 81 +/- 19 (38-134) ml/min/1.73m(2). All equations overestimated kidney function by 22-60 ml/min/1.73m(2). eGFR CysC had the lowest bias overall 22 (95% CI 20-26) ml/min/1.73m(2) also at all levels of kidney function we evaluated (at 30-59 ml/min/1.73m(2) bias was 27 (95% CI 21-35), at 60-89 it was 25 (95% CI 20-28) and at >= 90 it was 12 (95% CI 7-22)). eGFR CysC also had the best accuracy in patients with reduced kidney function (P10 was 5.9% at 30-59 ml/min/1.73m(2)). Conclusions Cystatin C-based estimations of kidney function performed better than creatinine-based ones in patients with primary neuromuscular disease, but most importantly, all evaluated equations overestimated kidney function, especially in patients with reduced kidney function. Therefore, kidney function should be measured by gold-standard methods when precision and accuracy are needed.