대한신장학회

논문분류	춘계학술대회 초록집
제목	Refining Pre-Donation Screening Through Creatinine–Cystatin C Co-measurement: From GFR Accuracy to Prognostic Discordance
저자	Jeeyoung Kim
출판정보	2026; 2026(1):
키워드	live kidney donor, eligibility, estimated GFR, measured GFR, 2021 CKD-EPI creatinine–cystatin C equation
초록	Objectives: In living kidney donor evaluation, glomerular filtration rate (eGFR) is typically estimated before proceeding to resource-intensive measured GFR (mGFR). However, creatinine-based eGFR alone may misclassify donor eligibility, particularly when cystatin C levels diverge — a phenomenon termed eGFR discordance. We hypothesized that this discordance reflects underlying physiological difference, with dual implications for accurate donor screening and post-donation renal risk stratification. Methods: We conducted a retrospective study of donor candidates who underwent simultaneous measurement of serum creatinine, cystatin C, and mGFR (⁹⁹mTc-DTPA clearance). We compared five eGFR equations — CKD-EPIcr (2009), CKD-EPIcys (2012), CKD-EPIcr (2021), CKD-EPIcr–cys (2021), and EKFCcr (2021) against mGFR with misclassification rate at the eligibility threshold of 90 mL/min/1.73 m². We then examined the association between magnitude and direction of cystatin C over creatinine-based eGFR discordance and post-donation acute kidney disease (AKD) with model performance assessed by using calibration plots. Results: Of 4,854 donor candidates, 1,405 were included (mean age 50.1 years; 45.8% male; mean BMI 24.5 kg/m²), the CKD-EPIcr–cys (2021) equation showed the best agreement with mGFR (Pearson r = 0.623, RMSE 17.7, P10 50.5%, P30 96.5%) with highest concordance across all age and sex subgroups. This equation had the lowest total misclassification rate (17.2%) and smallest mean absolute classified discordance (0.710). In addition, a greater positive discrepancy of eGFR was independently associated with lower odds of post-donation AKD (adjusted OR 0.68, 95% CI 0.57–0.81), with calibration plots confirming the robust predictive agreement. Conclusion: CKD-EPIcr–cys (2021) equation most accurately reflected mGFR, minimizing donor eligibility misclassification before confirmatory testing. Beyond accuracy, the discordance between its constituent biomarkers proves a physiologically meaningful signal — independently predicting post-donation AKD risk. These findings support routine co-measurement of creatinine and cystatin C as a standard component of pre-donation workup.
원문(PDF)	PDF 원문보기

간행물 검색

대한신장학회 회원관리 규정