Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States of America.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America.
PLoS One. 2020 Dec 11;15(12):e0243618. doi: 10.1371/journal.pone.0243618. eCollection 2020.
Serum creatinine (SCr) testing has been the mainstay of kidney function assessment for decades despite known limitations. Cystatin C (CysC) is an alternative biomarker that is generally less affected than SCr by pertinent non-renal factors in hospitalized patients, such as muscle mass. Despite its potential advantages, the adoption of CysC for inpatient care is not widespread. At one hospital with CysC testing, we demonstrated a significant rise in non-protocolized use over the last decade. This study uses qualitative methods to provide the first report of how clinicians understand, approach, and apply CysC testing in inpatient care.
Fifteen clinicians from various disciplines were interviewed about their experience with inpatient CysC testing. The semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed thematically using a phenomenological approach.
Knowledge and confidence with CysC varied greatly. Clinicians reported first learning about the test from colleagues on consulting services or multidisciplinary teams. The majority believed CysC to provide a more accurate measure of kidney function than SCr. Common scenarios for CysC ordering included medication dosing, evaluation of acute kidney injury, and a thorough evaluation of kidney function in patients with risk factors for an altered SCr. Facilitators for ordering CysC included the availability of rapid results turnaround and the automated calculation of glomerular filtration rate based on the biomarker. Barriers to use included a lack of education about CysC, and the absence of an institutional protocol for use.
Clinicians at our site decided independent of institutional guidance whether and when CysC added value to patient care. While the majority of study participants indicated advantages to rapid turnaround CysC testing, its use depended not just on the features of the specific case but on clinician familiarity and personal preference. Findings from this research can guide the implementation and expansion of CysC testing.
尽管血清肌酐（SCr）检测在过去几十年中一直是评估肾脏功能的主要方法，但它存在已知的局限性。胱抑素 C（CysC）是一种替代生物标志物，与住院患者相关的非肾脏因素（如肌肉量）相比，其一般受影响较小。尽管 CysC 具有潜在优势，但它在住院患者中的应用并不广泛。在一家进行 CysC 检测的医院，我们发现过去十年中，非协议性使用 CysC 的情况显著增加。本研究采用定性方法，首次报告了临床医生如何理解、处理和应用住院患者的 CysC 检测。
对来自不同学科的 15 名临床医生进行了有关住院患者 CysC 检测经验的访谈。半结构化访谈进行了录音，并逐字转录，然后采用现象学方法进行主题分析。
对 CysC 的了解和信心差异很大。临床医生表示，他们最初是从顾问服务或多学科团队的同事那里了解到该测试的。大多数人认为 CysC 比 SCr 能更准确地衡量肾功能。CysC 检测的常见情况包括药物剂量调整、急性肾损伤的评估以及有 SCr 改变风险因素的患者的全面肾功能评估。促进 CysC 检测的因素包括快速获得结果的可用性和基于生物标志物自动计算肾小球滤过率。使用的障碍包括缺乏有关 CysC 的教育，以及缺乏使用的机构协议。
我们医院的临床医生决定是否以及何时将 CysC 用于患者治疗，这是独立于机构指导的。虽然大多数研究参与者表示快速周转的 CysC 检测具有优势，但它的使用不仅取决于具体病例的特征，还取决于临床医生的熟悉程度和个人偏好。这项研究的结果可以为 CysC 检测的实施和扩展提供指导。
