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dc.contributor.authorVilar, Enric
dc.contributor.authorBoltiador, Capella
dc.contributor.authorViljoen, Adie
dc.contributor.authorMachado, Ashwini
dc.contributor.authorFarrington, Kenneth
dc.identifier.citationVilar , E , Boltiador , C , Viljoen , A , Machado , A & Farrington , K 2014 , ' Removal and rebound kinetics of cystatin C in high-flux hemodialysis and hemodiafiltration ' , Clinical Journal of the American Society of Nephrology , vol. 9 , no. 7 , pp. 1240-1247 .
dc.identifier.otherPURE: 10604615
dc.identifier.otherPURE UUID: 7eac4672-5144-40a2-8d9f-339d6efca37b
dc.identifier.otherPubMed: 24789553
dc.identifier.otherScopus: 84923832870
dc.descriptionCopyright © 2014 by the American Society of Nephrology.
dc.description.abstractBACKGROUND AND OBJECTIVES: Cystatin C is a 13.3 kD middle molecule of similar size to β2-microglobulin and a marker of GFR in CKD. This study aimed to determine cystatin C kinetics in hemodialysis to understand whether blood concentrations may predict residual renal function and middle-molecule clearance. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Cystatin C removal and rebound kinetics were studied in 24 patients on high-flux hemodialysis or hemodiafiltration. To determine whether cystatin C concentrations are predictable, an iterative two-pool mathematical model was applied. RESULTS: Cystatin C was cleared effectively, although less than β2-microglobulin (reduction ratios ± SD are 39% ± 11 and 51% ± 11). Cystatin C rebounded to 95% ± 5% of predialysis concentration by 12 hours postdialysis. The two-pool kinetic model showed excellent goodness of fit. Modeled extracellular cystatin C pool volume is smaller than that predicted, comprising 25.5% ± 9.2 of total body water. Iterated parameters, including nonrenal clearance, showed wide interindividual variation. Modeled nonrenal clearance was substantially higher than renal clearance in this population at 25.1 ± 6.6 ml/min per 1.73 m(2) body surface area. CONCLUSIONS: Plasma cystatin C levels may be used to measure middle-molecule clearance. Levels rebound substantially postdialysis and plateau in the interdialytic period. At low GFR, nonrenal clearance predominates over renal clearance, and its interindividual variation will limit use of cystatin C to predict residual renal function in advanced kidney disease.en
dc.relation.ispartofClinical Journal of the American Society of Nephrology
dc.subjectBody Surface Area
dc.subjectBody Water
dc.subjectCystatin C
dc.subjectExtracellular Fluid
dc.subjectGlomerular Filtration Rate
dc.subjectKidney Diseases
dc.subjectMiddle Aged
dc.subjectModels, Biological
dc.subjectMolecular Weight
dc.subjectPredictive Value of Tests
dc.subjectRenal Dialysis
dc.titleRemoval and rebound kinetics of cystatin C in high-flux hemodialysis and hemodiafiltrationen
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionHealth & Human Sciences Research Institute
dc.contributor.institutionCentre for Postgraduate Medicine
dc.contributor.institutionDepartment of Pharmacy, Pharmacology and Postgraduate Medicine
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.description.statusPeer reviewed
dc.relation.schoolSchool of Life and Medical Sciences
rioxxterms.typeJournal Article/Review

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