Removal and rebound kinetics of cystatin C in high-flux hemodialysis and hemodiafiltration

Enric Vilar, Capella Boltiador, Adie Viljoen, Ashwini Machado, Kenneth Farrington

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


BACKGROUND 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.

Original languageEnglish
Pages (from-to)1240-1247
Number of pages8
JournalClinical Journal of the American Society of Nephrology (CJASN)
Issue number7
Early online date1 May 2014
Publication statusPublished - 7 Jul 2014


  • Aged
  • Biomarkers
  • Body Surface Area
  • Body Water
  • Cystatin C
  • Extracellular Fluid
  • Female
  • Glomerular Filtration Rate
  • Hemodiafiltration
  • Humans
  • Kidney
  • Kidney Diseases
  • Kinetics
  • Male
  • Middle Aged
  • Models, Biological
  • Molecular Weight
  • Predictive Value of Tests
  • Renal Dialysis


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