{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:51:21Z","timestamp":1792788681857,"version":"4.5.0"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"Swedish Research Council","award":["2023-01807"],"award-info":[{"award-number":["2023-01807"]}],"id":[{"id":"https:\/\/ror.org\/03zttf063","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institutes of Health","award":["R01DK115534"],"award-info":[{"award-number":["R01DK115534"]}]},{"name":"Hj\u00e4rt-Lungfonden","award":["20250416"],"award-info":[{"award-number":["20250416"]}],"id":[{"id":"https:\/\/ror.org\/052261q33","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Westman Foundation"},{"name":"Njurfonden","id":[{"id":"https:\/\/ror.org\/01yra0v32","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Karolinska Institutet","id":[{"id":"https:\/\/ror.org\/056d84691","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Use of glucocorticoids, opioids, and loop diuretics raised cystatin C independent of GFR.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Except for glucocorticoids, cystatin C increases were small and likely clinically nonmeaningful.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            Consequently, the underestimation of eGFR\n                            <jats:sub>cys<\/jats:sub>\n                            was larger in medication users; combined eGFR\n                            <jats:sub>cr-cys<\/jats:sub>\n                            was most accurate.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Serum cystatin C is influenced by factors beyond GFR, and several medications have been hypothesized to alter its generation. Whether reported associations reflect effects on cystatin C independent of measured GFR (mGFR) or confounding by illness remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We studied 5595 adults who underwent outpatient cystatin C (and creatinine) testing with mGFR determination using iohexol clearance in Stockholm health care. Associations between eight candidate medication classes and cystatin C were assessed using both interindividual and intraindividual analyses, sequentially adjusting for mGFR, clinical variables, and ongoing medications. We further evaluated the effect of these medications on cystatin C\u2013based eGFR (eGFR\n                      <jats:sub>cys<\/jats:sub>\n                      ) bias compared with serum creatinine\u2013based (eGFR\n                      <jats:sub>cr<\/jats:sub>\n                      ) and combined (eGFR\n                      <jats:sub>cr-cys<\/jats:sub>\n                      ) equations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After adjustment for mGFR and confounders, the use of systemic glucocorticoids, opioids, and loop diuretics was associated with higher cystatin C. The magnitude of increase was potentially clinically meaningful for glucocorticoid use, particularly for greater estimated daily dose categories, whereas the smaller increases observed with opioid and loop diuretic use likely reflect clinically nonmeaningful effects. No associations were observed for use of allopurinol, immunosuppressants, thyroid hormone analogues, or antipsychotics or for paracetamol after adjustment for concomitant medications. eGFR\n                      <jats:sub>cys<\/jats:sub>\n                      underestimated mGFR more in users than in nonusers, while eGFR\n                      <jats:sub>cr<\/jats:sub>\n                      overestimated mGFR similarly in users and nonusers. eGFR\n                      <jats:sub>cr-cys<\/jats:sub>\n                      provided the least biased GFR estimates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study suggests that systemic glucocorticoids, opioids, and loop diuretics may increase cystatin C independent of mGFR. The use of eGFR\n                      <jats:sub>cr-cys<\/jats:sub>\n                      was consistently more accurate than either eGFR\n                      <jats:sub>cr<\/jats:sub>\n                      or eGFR\n                      <jats:sub>cys<\/jats:sub>\n                      alone in patients using these treatments.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.0000001108","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T16:01:42Z","timestamp":1776441702000},"page":"2221-2235","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Medications Influencing Serum Cystatin C Independent of Measured GFR"],"prefix":"10.1681","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6225-2325","authenticated-orcid":false,"given":"William A.","family":"Russel","sequence":"first","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3177-2279","authenticated-orcid":false,"given":"Rik Olde","family":"Engberink","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6498-0257","authenticated-orcid":false,"given":"Antoine","family":"Creon","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6019-9342","authenticated-orcid":false,"given":"Aurora","family":"Caldinelli","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6716-1157","authenticated-orcid":false,"given":"Anne-Laure","family":"Faucon","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4430-6023","authenticated-orcid":false,"given":"Morgan E.","family":"Grams","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9698-6825","authenticated-orcid":false,"given":"Edouard L.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-9482","authenticated-orcid":false,"given":"Lesley A.","family":"Inker","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1491-501X","authenticated-orcid":false,"given":"Andrew S.","family":"Levey","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4763-2024","authenticated-orcid":false,"given":"Juan Jesus","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 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