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Cystatin C: A Primer for Pharmacists

Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, USA
College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
Division of Epidemiology, Mayo Clinic, Rochester, MN 55905, USA
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
Author to whom correspondence should be addressed.
Pharmacy 2020, 8(1), 35;
Received: 11 December 2019 / Revised: 22 February 2020 / Accepted: 5 March 2020 / Published: 9 March 2020
(This article belongs to the Special Issue Pharmacokinetics of Drugs and Dosing in Kidney Disease)
Pharmacists are at the forefront of dosing and monitoring medications eliminated by or toxic to the kidney. To evaluate the effectiveness and safety of these medications, accurate measurement of kidney function is paramount. The mainstay of kidney assessment for drug dosing and monitoring is serum creatinine (SCr)-based estimation equations. Yet, SCr has known limitations including its insensitivity to underlying changes in kidney function and the numerous non-kidney factors that are incompletely accounted for in equations to estimate glomerular filtration rate (eGFR). Serum cystatin C (cysC) is a biomarker that can serve as an adjunct or alternative to SCr to evaluate kidney function for drug dosing. Pharmacists must be educated about the strengths and limitations of cysC prior to applying it to medication management. Not all patient populations have been studied and some evaluations demonstrated large variations in the relationship between cysC and GFR. Use of eGFR equations incorporating cysC should be reserved for drug management in scenarios with demonstrated outcomes, including to improve pharmacodynamic target attainment for antibiotics or reduce drug toxicity. This article provides an overview of cysC, discusses evidence around its use in medication dosing and in special populations, and describes practical considerations for application and implementation. View Full-Text
Keywords: cystatin C; biomarker; kidney function; pharmacokinetics; estimated glomerular filtration rate; muscle mass; sarcopenia; critical illness cystatin C; biomarker; kidney function; pharmacokinetics; estimated glomerular filtration rate; muscle mass; sarcopenia; critical illness
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Teaford, H.R.; Barreto, J.N.; Vollmer, K.J.; Rule, A.D.; Barreto, E.F. Cystatin C: A Primer for Pharmacists. Pharmacy 2020, 8, 35.

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