Unlike Scr, it does not depend on gender or muscle mass and does not change with age between 1 and 50 years old.24 Scys increases earlier than Scr as GFR decreases, so it

may be a valuable marker in detecting early renal dysfunction.25 and 26 In an early meta-analysis, Scys has also Alpelisib been reported to be superior to Scr for GFR estimation, particularly in patients with near-normal kidney function.27 In addition to its use in estimating GFR, cystatin C has also been associated with subsequent adverse clinical events. In prior studies in the general population and in the elderly, cystatin C has been shown to be a better predictor of mortality and adverse cardiovascular events than Scr alone.28, 29 and 30 Peralta et al31 studied cystatin C level in 11,909 participants and found its level may have a role in identifying individuals with CKD who have the highest risk for complications. The addition of cystatin C may improve mortality risk prediction by stages of kidney function relative to Scr.32 In our study, all 3 combined equations with Scys exhibited superior agreement and performance, but each of Gefitinib those equations also included patient height and

gender. However, including the height and gender does not explain totally the better performance of eGFR equations, because several other Scr-based equations used those variables as well. It is well known that a gender difference in the correlation of growth (height) and blood Scr concentration exists beginning in adolescence. This large variation in body

shape and linear height determines extreme variations in muscle mass and may be a dominant factor when developing eGFR formulas for children, teens, and young adults.6 Higher cystatin C concentrations have been found in the first year of life previously. Bökenkamp et al33 studied Scys level in 258 children without kidney disease, aged 1 day to 18 years, and found the cystatin C concentration was highest on the first days of life (range 1.64 ± 2.59 mg/L) with a rapid decrease during the first 4 months. Beyond the first year, the cystatin C concentration was constant. In a more recent study, Scys level Ribonucleotide reductase was found to be a superior biomarker to Scr in the assessment of GFR in premature infants.34 It is likely that the higher levels of cystatin C in the first year of life probably reflect the low GFR of neonates and infants. In our study, we only had 1 child under 1 year (0.7 years). There was a good agreement between mGFR and eGFR based on multivariate Schwartz equations. It should be noted that creatinine and cystatin C methodologies differ among the various equations and systematic differences in measurement could contribute to the accuracy of the equations, given the methods used in the present report.