{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:41:58Z","timestamp":1792773718458,"version":"4.5.0"},"reference-count":91,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Recognizing its clinical utility, the 2024 Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends using equations that integrate serum creatinine and cystatin C for CKD diagnosis and staging. Cystatin C\u2013inclusive equations generally outperform creatinine-based equations in bias and accuracy across diverse populations, including children and patients with comorbidities. Moreover, cystatin C\u2013inclusive equations consistently demonstrate greater prognostic value than creatinine-only equations for clinical outcomes such as kidney failure with replacement therapy, cardiovascular disease, and mortality, particularly in individuals with large differences between creatinine-based and cystatin C\u2013based eGFR. Among hospitalized patients and those undergoing significant changes in muscle mass, such as during weight loss or critical illness, cystatin C may improve GFR estimation and facilitate earlier detection of AKI. In clinical practice, cystatin C informs CKD staging, risk stratification, and medication dosing, particularly in scenarios where creatinine-based equations are less reliable. Although the integration of cystatin C into risk equations has shown mixed results, its inclusion enhances calibration in populations with frailty or large eGFR differences. Emerging evidence also supports the use of cystatin C in cancer care and kidney transplantation. Despite its promise, widespread clinical adoption of cystatin C faces several barriers, including in-house availability. To surmount these barriers, collaboration between nephrology and laboratory services is needed. As evidence grows, cystatin C\u2013based approaches have the potential to transform CKD detection and management. This study synthesizes recent evidence on cystatin C's role in GFR estimation, prognostic utility, and clinical applications, highlighting emerging areas and strategies for its implementation in health care systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.0000001201","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:00:22Z","timestamp":1783616422000},"page":"2042-2054","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Use of Cystatin C in Tandem with Creatinine to Improve GFR Estimation and Clinical Decision Making"],"prefix":"10.1681","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-3264","authenticated-orcid":false,"given":"Linda","family":"Awdishu","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice and Sciences, University of California \u2013 San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2781-3824","authenticated-orcid":false,"given":"Amy B.","family":"Karger","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9559-204X","authenticated-orcid":false,"given":"Michael G.","family":"Shlipak","sequence":"additional","affiliation":[{"name":"Kidney Health Research Collaborative, San Francisco VA Health Care System, University of California \u2013 San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8902-9576","authenticated-orcid":false,"given":"Michelle M.","family":"Estrella","sequence":"additional","affiliation":[{"name":"Kidney Health Research Collaborative, San Francisco VA Health Care System, University of California \u2013 San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"4S","key":"B1-20261023","first-page":"S117","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","year":"2024","journal-title":"Kidney Int."},{"issue":"1","key":"B2-20261023","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/ki.1995.40","article-title":"Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine","volume":"47","author":"Newman","year":"1995","journal-title":"Kidney Int."},{"issue":"suppl 1","key":"B3-20261023","first-page":"S20","article-title":"Diagnostic value of analysis of cystatin C and protein HC in biological fluids","volume":"38","author":"Grubb","year":"1992","journal-title":"Clin 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