Estimating Glomerular Filtration Rate in Cirrhosis Using Creatinine‐Based and Cystatin C–Based Equations: Systematic Review and Meta‐Analysis. Issue 11 (1st August 2021)

• Record Type: Journal Article
• Authors: Singapura, Prianka; Ma, Tsung‐Wei; Sarmast, Naveed; Gonzalez, Stevan A.; Durand, François; Maiwall, Rakhi; Nadim, Mitra K.; Fullinwider, John; Saracino, Giovanna; Francoz, Claire; Sartin, Rebecca; Trotter, James F.; Asrani, Sumeet K.
• Is Part Of: Liver transplantation. Volume 27:Issue 11(2021)
• Page Start: 1538
• Page End: 1552
• Publication Date: 2021-08-01
• Subjects: Liver -- Transplantation -- Periodicals; Liver -- Diseases -- Periodicals; Liver Transplantation -- Periodicals; Foie -- Greffe -- Périodiques; 617.5560592
• DOI: 10.1002/lt.26216
• Languages: English
• ISSNs: 1527-6465

Abstract

Abstract : Accurate estimation of kidney function in cirrhosis is crucial for prognosis and decisions regarding dual‐organ transplantation. We performed a systematic review/meta‐analysis to assess the performance of creatinine‐based and cystatin C (CysC)–based eGFR equations compared with measured GFR (mGFR) in patients with cirrhosis. A total of 25 studies (n = 4565, 52.0 years, 37.0% women) comprising 18 equations met the inclusion criteria. In all GFR equations, the creatinine‐based equations overestimated GFR (standardized mean difference, SMD, 0.51; 95% confidence interval [CI], 0.31‐0.71) and CysC‐based equations underestimated GFR (SMD, −0.3; 95% CI, −0.60 to −0.02). Equations based on both creatinine and CysC were the least biased (SMD, −0.14; 95% CI, −0.46 to 0.18). Chronic kidney disease–Epi–serum creatinine–CysC (CESC) was the least biased but had low precision and underestimated GFR by −3.6 mL/minute/1.73 m 2 (95% CI, −17.4 to 10.3). All equations significantly overestimated GFR (+21.7 mL/minute/1.73 m 2 ; 95% CI, 17.7‐25.7) at GFR <60 mL/minute/1.73 m 2 ; of these, chronic kidney disease–Epi–CysC (10.3 mL/minute/1.73 m 2 ; 95% CI, 2.1‐18.4) and GFR Assessment in Liver Disease (12.6 mL/minute/1.73 m 2 ; 95% CI, 7.2‐18.0) were the least biased followed by Royal Free Hospital (15 mL/minute/1.73 m 2 ; 95% CI, 5.5‐24.6) and Modification of Diet in Renal Disease 6 (15.7 mL/minute/1.73 m 2 ; 95% CI, 10.6‐20.8); however, there was an overlap in the precision of estimates, and the studies were limited. In ascites, overestimation of GFR was common (+8.3 mL/minute/1.73 m 2 ; 95% CI, −3.1 to 19.7). However, overestimation of GFR by 10 to 20 mL/minute/1.73m 2 is common in patients with cirrhosis with most equations in ascites and/or kidney dysfunction. A tailored approach is required especially for decisions regarding dual‐organ transplantation.