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An Appropriate Assessment of Kidney Function In Patients with End Stage Liver Disease: Role of Cystatin C

Kaiser, Tiffany E
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532967

Abstract Details

2014, MS, University of Cincinnati, Medicine: Epidemiology (Environmental Health).
Introduction: Currently, there are no accurate methods to assess kidney function in the setting of end stage liver disease (ESLD) prior to orthotopic liver transplantation (OLT). Traditional, proven, non-invasive measures, such as serum creatinine (sCr) are inaccurate secondary to reduced creatinine production. Consequently, renal function is underestimated and under-diagnosed resulting in inappropriate post-OLT management leading to further progression of renal disease. A more accurate assessment of renal function at the time of OLT beyond sCr would aid clinicians in identifying the subgroup of patients with baseline disease and allow for the selection of less nephrotoxic immunosuppressant regimens post-OLT. Cystatin C (Cys C), a low molecular weight cystine protease inhibitor, has been proposed as a reliable marker of kidney function in these patients because its production is independent of muscle mass. The objective of this study was to compare Cys C and traditional markers for estimating renal function in patients with ESLD undergoing OLT. It was hypothesized that Cys C will provide a more accurate measure of renal function when compared to traditional sCr based estimations. Methods: Adult non-fulminant patients’ waitlisted for OLT able to make at least 1 liter of urine per day and able to give informed consent were enrolled. Patients undergoing renal dialysis or listed for multiple organ transplants were excluded. Glomerular filtration rate (GFR) was measured by a 24-hour urine collection, and calculated from multiple sCr and Cys C based estimating equations pre-OLT and on post-OLT days 7, 30, 180 and 365. Pearson correlation was performed to compare GFR estimates at each visit and across visits. Mixed model regression analysis was performed to compare estimates across visits. Additionally, the coefficient of variation (CV) was utilized to describe the degree of variation amongst the data. Results: 43 subjects were enrolled and 18 included in the final analysis. Mean age 56.6 + 7.8 years, median MELD 20 (range 16 – 41). Indications for OLT varied. 100% of subjects completed the first visit pre-OLT with less completing the post-OLT visits from 61-83%. The percent of assessments collected was less than expected with 96%, 57%, 70%, 57% and 57% collected for visits 1 through 5 respectively. CysC and sCr based GFR estimates were associated at many time points with varying significance. There was a high degree of variability amongst the data. Conclusion: The lack of a gold standard GFR measure, a large percentage of incomplete or missing assessments and the high degree of variability within the data place doubt over the utility of our study findings in clinical practice. No new information or evidence that Cys C provides any advantage over the traditional sCr based estimations of GFR in patients with ESLD listed for OLT or OLT recipients was provided by our study. Additional studies are needed to identify more suitable measures or perhaps better ways to use the current estimates of GFR within this specific patient population.
Paul Succop, Ph.D. (Committee Chair)
Rita Alloway, Pharm.D. (Committee Member)
33 p.
Surgery
Cystatin C; Glomerular Filtration Rate; Cirrhosis; Liver Transplantation; Serum Creatinine

Recommended Citations

Citations

  • Kaiser, T. E. (2014). An Appropriate Assessment of Kidney Function In Patients with End Stage Liver Disease: Role of Cystatin C [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532967

    APA Style (7th edition)

  • Kaiser, Tiffany. An Appropriate Assessment of Kidney Function In Patients with End Stage Liver Disease: Role of Cystatin C. 2014. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532967.

    MLA Style (8th edition)

  • Kaiser, Tiffany. "An Appropriate Assessment of Kidney Function In Patients with End Stage Liver Disease: Role of Cystatin C." Master's thesis, University of Cincinnati, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532967

    Chicago Manual of Style (17th edition)

ucin1396532967
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© 2014, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.