FORM-2C (Frequency of Renal Monitoring – Creatinine and Cystatin C): an observational cohort study of primary care patients with reduced eGFR

Fleming, S; Perera-Salazar, R; Taylor, K; Jones, L; Hobbs, FDR; james, T; O'callaghan, C; Shine, B; verbackel, J; Stevens, R; Bankhead, C

Journal article

FORM-2C (Frequency of Renal Monitoring – Creatinine and Cystatin C): an observational cohort study of primary care patients with reduced eGFR

Abstract:: Background: Monitoring is the mainstay of chronic kidney disease management in primary care. There is little evidence on how best to monitor.

Aim: To compare the effectiveness of eGFR derived from creatinine or cystatin C, to predict renal function decline among those with a recent eGFR of 30-89 ml/min/1.73m².

Design and setting: Observational cohort study in UK primary care.

Method: In 750 adult patients with a recent estimated glomerular filtration rate (eGFR) of 30-89 ml/min/1.73m² both creatinine and cystatin C were measured at seven study visits over two years. The primary outcome was change in eGFR derived from creatinine or cystatin C between 6 and 24 months.

Results: Average change in eGFR was 0.51 ml/min/1.73m²/year or -2.35 ml/min/1.73m²/year when estimated by creatinine or cystatin C respectively. The c-statistic for predicting renal decline using creatinine-derived eGFR was 0.495 (95% CI 0.471 to 0.519). The equivalent c-statistic using cystatin C-derived eGFR was 0.497 (95% CI 0.468 to 0.525). Similar results were obtained when restricting analyses to those over or under 75 years, or with eGFR above 60 ml/min/1.73m2. In those with eGFR below 60 ml/min/1.73m2 cystatin C-derived eGFR was more predictive than creatinine-derived eGFR for future decline.

Conclusion: In the primary analysis neither eGFR estimated from creatinine nor cystatin C predicted future change in kidney function, partly due to small changes during two years. In some secondary analyses there was a suggestion that cystatin C to estimate eGFR was a more useful biomarker, especially in those with baseline eGFR < 60 ml/min/1.73m2.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Fleming, S., Perera-Salazar, R., Taylor, K., Jones, L., Hobbs, F. D. R., james, T., O'callaghan, C., Shine, B., verbackel, J., Stevens, R., & Bankhead, C. (2021). FORM-2C (Frequency of Renal Monitoring – Creatinine and Cystatin C): an observational cohort study of primary care patients with reduced eGFR. British Journal of General Practice, 71(710), e677–e684.

MLA Style

Fleming, S, et al. “FORM-2C (Frequency of Renal Monitoring – Creatinine and Cystatin C): an Observational Cohort Study of Primary Care Patients with Reduced EGFR.” British Journal of General Practice, vol. 71, no. 710, 2021, pp. e677–e684.

Chicago Style

Fleming, S, R Perera-Salazar, K Taylor, et al. 2021. “FORM-2C (Frequency of Renal Monitoring – Creatinine and Cystatin C): an Observational Cohort Study of Primary Care Patients with Reduced EGFR.” British Journal of General Practice 71 (710): e677–e684.
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