How Cystatin C measurement contributes to health care equity

Presented By:
Gabriella Lakos MD, PhD, D (ABMLI)

Speaker Biography:
Dr. Gabriella Lakos received her medical degree at the University Medical School of Debrecen, Hungary, where she also earned a PhD degree in Clinical Immunology.

She is a clinical pathologist, with board certifications in Transfusion Medicine, Clinical Pathology and Medical Laboratory Immunology, and with over 15 years of hands-on and management experience in the clinical laboratory. Before joining The Binding Site, she has held various leadership positions in the IVD industry, including Medical Director of Abbott Hematology, and Director of Assay Development and Medical Director at Inova Diagnostics. She has authored or co-authored numerous peer-reviewed publications and book chapters, and mentored trainees and PhD students. Gabriella is an active member of the American Association for Clinical Chemistry (AACC), the Association of Medical Laboratory Immunologists (AMLI), the International Society for Laboratory Hematology (ISLH) and the American Society of Hematology (ASH). She is the Industry Representative on the Pathology and Hematology Devices FDA Advisory Panel. Gabriella is passionate about encouraging the study, advancing the science, and improving the practice of diagnostic immunology.

How Cystatin C measurement contributes to health care equity

Webinar Abstract:
Kidney function is assessed in the laboratory by measuring serum creatinine (Cr) and/or Cystatin C (CysC) and estimating glomerular filtration rate (GFR) using equations. Since 2009 the most frequently used equation has been the 2009 CKD-EPI equation, which includes Cr, age, sex and race in the equation (eGFRcr). This has resulted in higher eGFRs for individuals who are identified as Black compared with non-Blacks, and has been linked to disparities in care, including delays in the diagnosis of kidney disease and eligibility for kidney transplantation.

Race is viewed as a social construct, which ignores diversity within and among racial groups, and including race in GFR estimating equations may contribute to systemic racism in medicine. The National Kidney Foundation and the American Society of Nephrology (NKF-ASN) has re-assessed the inclusion of race in the estimation of GFR in the US and its implications for diagnosis and patient management. As a result, they have refitted the CKD-EPI equation without the race variable and recommended the immediate implementation of the 2021 CKD-EPI equation. Their second recommendation was to facilitate the increased, routine and timely use of CysC. CysC is non-glycosylated protein that is produced by all nucleated cells and is freely filtered by the glomerulus. It appears to be less affected by age, sex, muscle mass, diet and race than Cr. The current CysC-based equation for eGFR (eGFRcys) does not include race, but has similar accuracy as the 2009 eGFRcr, therefore no refit was needed. The 2009 eGFRcr-cys equation (that uses both Cr and CysC measurements), however, has also been refitted to not include race, and currently provides the most accurate GFR estimation among the various equations.

Offering CysC in the laboratory therefore may facilitate racial bias-free kidney function assessment and increase the accuracy of eGFR.

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