Objectives: To investigate serum Cystatin C level, percentage of elevated serum cystatin C in prediabetic, type 2 diabetic patients. Relationship between serum Cystatin C levels and albuminuria in prediabetes. Correlation between serum Cystatin C levels and estimated glomerular filtration rate (eGFR), renal radiography in type 2 diabetic patients.
Materials and methods: 90 healthy subjects, 60 patients with prediabetes, and 124 type 2 diabetic patients were inrolled into this study. We excluded patients with thyroid dysfunction and those taking glucocorticoids that affect the serum Cystatin level. The serum Cystatin C and Creatinine, renal radiography, albuminuria, and eGFR using CKD.EPI, MDRD formular were calculated. Descriptive and cross-sectional study. Analyzed correlation, Receiver operating characteristics (ROC), calculated the area under the curve (AUC) for serum Cystatin C.
Results: The level of serum Cystatin C gradually significantly increased in healthy subjects, prediabetes, and type 2 diabetic patients (0.848±0.097; 0.894±0.113; 1.410±0.900 mg/L, p<0.05, respectively). Percentage of elevated serum cystatin C in prediabetic and type 2 diabetic patients were 13%, 47.6%, p<0.05, respectively. There was a positive correlation of serum cystatin C with albuminuria, a negatively correlation between serum Cystatin C level and eGFR in prediabetic subjects.There was a strong positively correlation of eGFR according to CKD.EPI equation based on serum Cystatin C (r=0.804, p < 0.001) and renal radiography (r=0.767, p<0.001). The strong positively correlation between eGFR based on serum Creatinine-Cystatin C and renal radiography (r=0.804, p<0.001). Serum Cystatin C level was significantly negatively correlation with eGFR based on cystatin C serum (r=-0.861, p<0.001) and renal radiography (r=0.739 p<0.001). The cut off value for the identification of GFR < 60ml/min/1.73m2 was 1.53mg/l with a sensitivity of 93.6 (95%CI: 78.3- 96.3) and specificity of 97.4 (95%CI: 88.0- 98.2), AUC was 0.96 according to renal radiography.The cutoff value for the identification of GFR < 60ml/min/1.73m2 was 1.3mg/l with a sensitivity of 100,0 (95%CI: 91.3- 100.0) and specificity of 94.0 (95%CI: 86.5- 98,0), AUC was 0,989 according to CKD.EPI formular based on Cystatin C.
Conclusions: The level of serum Cystatin C gradually significantly increased in healthy subjects, prediabetes, and type 2 diabetic patients. There was a correlation of serum cystatin C with albuminuria, eGFR in prediabetic subjects. There was a positive correlation between eGFR based on Cystatin C and renal radiography. A negativelysignificantly correlation between serum Cystatin C level and eGFR,renal radiography. Serum Cystatin C had strong sensitivityand specificity for detecting reduced GFR.
Key words: prediabetes, diabetes mellitus, glomerular filtration rate, Cystatin C, albuminuria
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