Diagnostic Accuracy of Serum Cystatin C for the Evaluation of Renal Dysfunction in Diabetic Patients: A Meta-Analysis
Shi-kun Yang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
These authors contribute equally to this work.Search for more papers by this authorJun Liu
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
These authors contribute equally to this work.Search for more papers by this authorXian-ming Zhang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
These authors contribute equally to this work.Search for more papers by this authorChun Hu
Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
Search for more papers by this authorWei Zhang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
Search for more papers by this authorLin Sun
Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
Search for more papers by this authorCorresponding Author
Hao Zhang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
Address correspondence and reprint requests to Dr. Hao Zhang, Department of Nephrology, The Third Xiangya Hospital, Central South University, Tongzipo Road No.138, Changsha, Hunan Province, China 410013, Telephone: 86-731-88618238, Fax: 86-731-88618210. Email: [email protected]Search for more papers by this authorShi-kun Yang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
These authors contribute equally to this work.Search for more papers by this authorJun Liu
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
These authors contribute equally to this work.Search for more papers by this authorXian-ming Zhang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
These authors contribute equally to this work.Search for more papers by this authorChun Hu
Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
Search for more papers by this authorWei Zhang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
Search for more papers by this authorLin Sun
Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
Search for more papers by this authorCorresponding Author
Hao Zhang
Departments of Nephrology, The Third Xiangya Hospital Central South University, Changsha, Hunan Province, China
Address correspondence and reprint requests to Dr. Hao Zhang, Department of Nephrology, The Third Xiangya Hospital, Central South University, Tongzipo Road No.138, Changsha, Hunan Province, China 410013, Telephone: 86-731-88618238, Fax: 86-731-88618210. Email: [email protected]Search for more papers by this authorAbstract
This study aimed to evaluate the diagnostic value of serum cystatin C for renal dysfunction in diabetic patients. Eligible trials were searched from multiple databases, the data were extracted into a 2 × 2 table after the quality assessment of included articles. The pooled sensitivity, specificity and other parameters of accuracy of cystatin C were analyzed using Stata version 12.0. Seventeen studies involving 2173 patients were included. The pooled sensitivity and specificity of serum cystatin C for the diagnosis of renal dysfunction were 0.88 (95% CI: 0.83–0.91) and 0.87 (95% CI: 0.82–0.91), respectively. The positive likelihood ratio was 6.69 (95% CI: 4.83–9.26), negative likelihood ratio was 0.14 (95% CI: 0.10–0.20) and diagnostic odds ratio (DOR) was 46.57 (95% CI: 27.76–78.13). The area under the receiver operating characteristic curve was 0.94. Analysis of the 12 studies that investigated serum creatinine indicated that serum cystatin C was more accurate than serum creatinine for the diagnosis of renal dysfunction. Our results indicate that serum cystatin C is an effective index in diagnosing renal dysfunction comparing serum creatinine, serum cystatin C is more sensitivity for evaluation of renal function in diabetic patients.
References
- 1Rossing P. Diabetic nephropathy: worldwide epidemic and effects of current treatment on natural history. Curr Diab Rep 2006; 6: 479–83.
- 2Soveri I, Berg UB, Bjork J et al. Measuring GFR: a systematic review. Am J Kidney Dis 2014; 64: 411–24.
- 3Filler G, Yasin A, Medeiros M. Methods of assessing renal function. Pediatr Nephrol 2014; 29: 183–92.
- 4Lim WH, Lewis JR, Wong G et al. Plasma neutrophil gelatinase-associated lipocalin and kidney function decline and kidney disease-related clinical events in older women. Am J Nephrol 2015; 41: 156–64.
- 5Onopiuk A, Tokarzewicz A, Gorodkiewicz E. Cystatin C: a kidney function biomarker. Adv Clin Chem 2015; 68: 57–69.
- 6Shlipak MG, Matsushita K, Arnlov J et al. Cystatin C versus creatinine in determining risk based on kidney function. N Engl J Med 2013; 369: 932–43.
- 7Allen AM, Kim WR, Larson JJ, Colby C, Therneau TM, Rule AD. Serum cystatin C as an indicator of renal function and mortality in liver transplant recipients. Transplantation 2015; 99(7): 1431–5.
- 8Woo KS, Choi JL, Kim BR, Kim JE, Han JY. Clinical usefulness of serum cystatin C as a marker of renal function. Diabetes Metab J 2014; 38: 278–84.
- 9Pan P, Binjie H, Min L et al. A Meta-analysis on diagnostic value of serum cystatin C and creatinine for the evaluation of glomerular filtration function in renal transplant patients. Afr Health Sci 2014; 14: 1025–35.
- 10Zhang M, Cao X, Cai G et al. Clinical evaluation of serum cystatin C and creatinine in patients with chronic kidney disease: a meta-analysis. J Int Med Res 2013; 41: 944–55.
- 11Roos JF, Doust J, Tett SE, Kirkpatrick CM. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children–a meta-analysis. Clin Biochem 2007; 40(5-6): 383–91.
- 12Stroup DF, Berlin JA, Morton SC et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283(15): 2008–12.
- 13Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003; 3: 25.
- 14van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 2002; 21(4): 589–24.
- 15Schisterman EF, Perkins NJ, Liu A, Bondell H. Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology 2005; 16(1): 73–81.
- 16Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005; 58(10): 982–90.
- 17Chappell FM, Raab GM, Wardlaw JM. When are summary ROC curves appropriate for diagnostic meta-analyses? Stat Med 2009; 28(21): 2653–68.
- 18Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21(11): 1539–58.
- 19Deeks JJ, MaCaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005; 58(9): 882–93.
- 20Chae HW, Shin JI, Kwon AR, Kim HS, Kim DH. Spot urine albumin to creatinine ratio and serum cystatin C are effective for detection of diabetic nephropathy in childhood diabetic patients. J Korean Med Sci 2012; 27(7): 784–7.
- 21El-Shafey EM, El-Nagar GF, Selim MF, El-Sorogy HA, Sabry AA. Is serum cystatin C an accurate endogenous marker of glomerular filtration rate for detection of early renal impairment in patients with type 2 diabetes mellitus? Ren Fail 2009; 31(5): 355–9.
- 22Harmoinen AP, Kouri TT, Wirta OR et al. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes. Clin Nephrol 1999; 52(6): 363–70.
- 23Jeon YK, Kim MR, Huh JE et al. Cystatin C as an early biomarker of nephropathy in patients with type 2 diabetes. J Korean Med Sci 2011; 26(2): 258–63.
- 24Jeon YL, Kim MH, Lee WI, Kang SY. Cystatin C as an early marker of diabetic nephropathy in patients with type 2 diabetes. Clin Lab 2013; 59(11-12): 1221–9.
- 25Kimura T, Ikeda H, Fujikawa J et al. Usefulness of serum cystatin C in Japanese patients with type 2 diabetes mellitus and nephropathy. Diabetes Res Clin Pract 2009; 83(2): e58–61.
- 26Macisaac RJ, Tsalamandris C, Thomas MC et al. The accuracy of cystatin C and commonly used creatinine-based methods for detecting moderate and mild chronic kidney disease in diabetes. Diabet Med 2007; 24: 443–48.
- 27Mojiminiyi OA, Abdella N. Evaluation of cystatin C and beta-2 microglobulin as markers of renal function in patients with type 2 diabetes mellitus. J Diabetes Complications. 2003; 17: 160–8.
- 28Mussap M, Dalla Vestra M, Fioretto P et al. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int. 2002; 61: 1453–61.
- 29Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes. Am J Kidney Dis 2001; 38: 310–16.
- 30Perlemoine C, Beauvieux MC, Rigalleau V et al. Interest of cystatin C in screening diabetic patients for early impairment of renal function. Metabolism 2003; 52: 1258–64.
- 31Pucci L, Triscornia S, Lucchesi D et al. Cystatin C and estimates of renal function: searching for a better measure of kidney function in diabetic patients. Clin Chem 2007; 53: 480–8.
- 32Uslu S, Efe B, Alatas O et al. Serum cystatin C and urinary enzymes as screening markers of renal dysfunction in diabetic patients. J Nephrol 2005; 18: 559–67.
- 33Xia LH, Bing XG, An XT. Serum cystatin C assay for the detection of early renal impairment in diabetic patients. J Clin Lab Anal 2004; 18: 31–5.
- 34Wang JB, Pan WY, Sun L et al. The application of cystatin C and estimated glomerular filtration rate in diagnosis of early diabetic nephropathy. Shanxi Med J 2009; 38: 354–7.
- 35Cheng Y, Li NN, Liu JJ et al. Evaluation with ROC curve of the diagnostic value of serum cystatin C for diabetic nephropathy. Medical Journal of National defending forces in Southwest China 2014; 24: 715–18.
- 36Zhao YJ, Sang HY. The value of serum cystatin C for detecting early renal impairment in elderly patients with diabetic nephropathy. Chin J Gerontol 2012; 32(9): 4014–15.
- 37Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002; 40(2): 221–6.
- 38Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem 2002; 48(5): 699–707.
- 39Kanwar YS, Sun L, Xie P, Liu FY, Chen S. A glimpse of various pathogenetic mechanisms of diabetic nephropathy. Annu Rev Pathol 2011; 6: 395–423.
- 40Hemmelgarn BR, Zhang J, Manns BJ et al. Progression of kidney dysfunction in the community-dwelling elderly. Kidney Int 2006; 69(12): 2155–61.
- 41Tsalamandris C, Allen TJ, Gilbert RE et al. Progressive decline in renal function in diabetic patients with and without albuminuria. Diabetes 1994; 43(5): 649–55.
- 42Huddam B, Azak A, Kocak G, Bayraktar N, Sezer S. The relationship between serum fetuin-A, cystatin-C levels, and microalbuminuria in patients with metabolic syndrome. J Clin Lab Anal 2013; 27(4): 317–22.
- 43Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM. Systematic reviews of diagnostic test accuracy. Ann Intern Med 2008; 149(12): 889–97.
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