Comparison of diagnostic significance of calculation of glomerular filtration rate based on creatinine and cystatin c in patients with chronic obstructive pulmonary disease

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Abstract

Goal. Comparison of the diagnostic significance of calculating the filtration rate based on creatinine and cystatin C in patients with chronic obstructive pulmonary disease (COPD).

Material and methods. 198 patients with COPD of 1–4 degrees of severity (GOLD 2014) who were examined and treated at the regional hospital № 2 were examined. The average age of the subjects was 63,5±5,7 years, the duration of COPD was 13,1±4,6 years. The control group consisted of 28 healthy volunteers, comparable in age and gender. In addition to general clinical studies, all patients were calculated the glomerular filtration rate (GFR) based on the level of serum creatinine (GFRcr) and, additionally, based on serum cystatin C (GFRcys), as well as a bioimpedance study of body composition according to the standard method.

Results. It was found that when calculating GFR by creatinine, the frequency of COPD patients with a normal GFR level>90 ml/min/1,73 m2 was statistically significantly higher than when calculating cystatin C (37,1% vs 12.6%, respectively, χ2=52,97; p=0,005). For a group of patients with a decrease in GFR in the range of 59–45 ml/min/1,73 m2, the opposite results were obtained: the proportion of patients with the calculation of GFR for cystatin C was statistically significantly higher (34,3% vs 1%, respectively, χ2=48,87; p=0,002). Similar data were obtained when comparing alternative and standard methods in the groups of GFR 44–30 ml/min/1,73 m2 (12,1% for cystatin C vs 0% for creatinine χ2=28,97; p=0,03) and GFR 29-15 ml/min/1,73 m2 (5,1% for cystatin C vs 0% for creatinine, χ2=5,13; p=0,04). Only in the group with a slight decrease in GFR (89–60 ml/min/1,73 m2), there were no statistically significant differences between the methods used (51% for creatinine vs 35,8% for cystatin C, χ2=2,95; p=0,06). In the group of healthy volunteers, there was no statistically significant difference between the standard and alternative methods. A high frequency of muscle dysfunction was found in COPD patients (57,6%) according to bioimpedance analysis, as well as statistically significant correlations between the level of serum creatinine and indicators reflecting the state of muscle tissue.

Conclusions. Underdiagnosis of GFR reduction in COPD patients was revealed using a standard calculation method based on serum creatinine.

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About the authors

Elena V. Bolotova

Kuban State Medical University of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: bolotowa_e@mail.ru
ORCID iD: 0000-0001-6257-354X

Dr. Sci. (Med.), Professor at the Department of Therapy № 1 FATPRS, Kuban State Medical University

Russian Federation, Krasnodar

Anna V. Dudnikova

Kuban State Medical University of the Ministry of Healthcare of the Russian Federation

Email: avdudnikova@yandex.ru
ORCID iD: 0000-0003-2601-7831

Cand.Sci. (Med.), Therapist at the Consultative and Diagnostic Department, Clinic of the Kuban State Medical University

Russian Federation, Krasnodar

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