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| Situation | Preferred Marker | |---|---| | Muscular patient (bodybuilder, TRT user) | Cystatin C | | Sarcopenic elderly patient | Cystatin C | | Acute kidney injury monitoring (daily changes) | Creatinine (faster turnaround, cheaper) | | GFR near 60 mL/min/1.73m (staging uncertainty) | Both (combined CKD-EPI 2021) | | Screening in general population | Creatinine (cost-effective first step) | | Pre-contrast CT or MRI decision | Cystatin C if creatinine is borderline | | Drug dosing confirmation in G3 CKD | Both | The 2022 NKF-ASN Task Force concluded: "We recommend reporting eGFR using both creatinine and cystatin C when eGFR confirmation is needed for clinical decisions" (NKF/ASN Task Force, JASN 2022)