ArticleKidney medicine2026
The Precision and Accuracy of Chronic Kidney Disease Epidemiology Collaboration Creatinine, Cystatin C, and Creatinine-Cystatin C Equations in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.
Article in Kidney medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
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Abstract
Rationale & Objective: Cystatin C offers advantages over creatinine for estimating glomerular filtration rate (GFR) because of its reduced dependence on muscle mass. Although the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines support its use in chronic kidney disease, specific guidance for kidney transplant recipients (KTRs) remains limited. This systematic review and meta-analysis evaluated the precision and accuracy of cystatin C-based, creatinine-based, and combined creatinine- and cystatin C-based equations compared with measured GFR in KTRs. Study Design: Systematic review and meta-analysis. Setting & Study Populations: Published studies evaluating the performance of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations among adult KTRs. Selection Criteria for Studies: The peer-reviewed studies reporting CKD-EPI-based estimated GFR (eGFR) compared with measured GFR, including data on mean bias and/or accuracy metrics (P30 or P10). Data Extraction: Two reviewers independently extracted study characteristics, GFR measurement methods, equation type, mean bias, and accuracy outcomes. Discrepancies were resolved through consensus. Analytical Approach: Random-effects meta-analyses were performed to estimate pooled mean bias and accuracy within 30% (P30) and 10% (P10) of measured GFR, with 95% confidence intervals (CIs). Heterogeneity was quantified using the I Results: Twenty-six studies met inclusion criteria; 14 provided extractable CKD-EPI bias data (4,041 adult KTRs; 11,997 repeated measures). The combined creatinine-cystatin C equation had the lowest pooled mean bias (0.63 mL/min/1.73 m Limitations: Heterogeneity in GFR measurement methods, assay calibration, and timing post-transplant. Conclusions: Across heterogeneous KTR studies, the CKD-EPI creatinine-cystatin C equation demonstrates lower mean bias and slightly higher pooled P30 than single-marker equations in population-level assessment. When cystatin C is available, the combined equation is a reasonable choice. Further multicenter validation studies with harmonized biomarker protocols are needed to confirm its clinical utility in KTRs. Registration: PROSPERO (CRD42024506221).
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