Cystatin C as a Predictor of Renal Function and Methotrexate-Associated Toxicities in Patients With Rheumatoid Arthritis
OBJECTIVE: Methotrexate (MTX) is an anchor drug for most patients with rheumatoid arthritis (RA); however, its use may be limited depending on renal function. Therefore, this study aimed to examine the discrepancy in the estimated glomerular filtration rate (eGFR) using conventional serum creatinine (SCr)-, cystatin C-, and MTX-associated toxicities in patients with RA.
METHODS: In total, 436 patients were enrolled, and eGFR was evaluated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on both cystatin C and SCr levels. The CKD and MTX dosing stages were classified according to eGFR. MTX-associated toxicities were also evaluated.
RESULTS: The mean eGFR using CKD-EPI cystatin C (CKD-EPIcys) was 89.44 mL/min/1.73 m2, lower than the eGFR using CKD-EPI SCr (CKD-EPISCr) of 95.55 mL/min/1.73 m2. After converting eGFR to CKD-EPIcys by CKD-EPISCr, 29.8% of patients were reclassified to a higher stage according to the Kidney Disease: Improving Global Outcomes CKD stage. Also, according to the MTX guidelines, 6.4% of the group with an eGFR > 50 mL/min/1.73 m2 were reclassified to eGFR 10-50 mL/1.73 m2, requiring dose adjustment. The incidence of MTX-associated toxicities, such as anemia, leukopenia, and nephrotoxicity, was significantly higher in the CKD stage-changed group than in the nonstage-changed group.
CONCLUSION: Our results showed that eGFR based on SCr was overestimated compared with eGFR based on cystatin C. In addition, we demonstrated that MTX-associated toxicities were significantly increased in the group with a changed stage when the eGFR was converted from CKD-EPISCr to CKD-EPIcys.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
The Journal of rheumatology - (2023) vom: 01. Okt. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kwon, Hyeok Chan [VerfasserIn] |
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| Anmerkungen: |
Date Revised 15.10.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.3899/jrheum.2023-0218 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM362746419 |
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| 100 | 1 | |a Kwon, Hyeok Chan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cystatin C as a Predictor of Renal Function and Methotrexate-Associated Toxicities in Patients With Rheumatoid Arthritis |
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| 500 | |a Date Revised 15.10.2023 | ||
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| 500 | |a Citation Status Publisher | ||
| 520 | |a OBJECTIVE: Methotrexate (MTX) is an anchor drug for most patients with rheumatoid arthritis (RA); however, its use may be limited depending on renal function. Therefore, this study aimed to examine the discrepancy in the estimated glomerular filtration rate (eGFR) using conventional serum creatinine (SCr)-, cystatin C-, and MTX-associated toxicities in patients with RA | ||
| 520 | |a METHODS: In total, 436 patients were enrolled, and eGFR was evaluated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on both cystatin C and SCr levels. The CKD and MTX dosing stages were classified according to eGFR. MTX-associated toxicities were also evaluated | ||
| 520 | |a RESULTS: The mean eGFR using CKD-EPI cystatin C (CKD-EPIcys) was 89.44 mL/min/1.73 m2, lower than the eGFR using CKD-EPI SCr (CKD-EPISCr) of 95.55 mL/min/1.73 m2. After converting eGFR to CKD-EPIcys by CKD-EPISCr, 29.8% of patients were reclassified to a higher stage according to the Kidney Disease: Improving Global Outcomes CKD stage. Also, according to the MTX guidelines, 6.4% of the group with an eGFR > 50 mL/min/1.73 m2 were reclassified to eGFR 10-50 mL/1.73 m2, requiring dose adjustment. The incidence of MTX-associated toxicities, such as anemia, leukopenia, and nephrotoxicity, was significantly higher in the CKD stage-changed group than in the nonstage-changed group | ||
| 520 | |a CONCLUSION: Our results showed that eGFR based on SCr was overestimated compared with eGFR based on cystatin C. In addition, we demonstrated that MTX-associated toxicities were significantly increased in the group with a changed stage when the eGFR was converted from CKD-EPISCr to CKD-EPIcys | ||
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| 700 | 1 | |a Kim, So Mi |e verfasserin |4 aut | |
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