Cross-Sectional and Longitudinal Performance of Creatinine-and Cystatin C-Based Estimating Equations Relative to Exogenously Measured Glomerular Filtration Rate in HIV-Positive and HIV-Negative Persons

Gregory M. Lucas, Mohamed G. Atta, Katie Zook, Dhananjay Vaidya, Xueting Tao, Paula Maier, George J. Schwartz

Research output: Contribution to journalArticlepeer-review

Abstract

Background:Reliable estimates of glomerular filtration rate (GFR) are important in the clinical management of HIV-positive patients. Data on the performance of widely used estimating equations (eGFR) relative to exogenously measured GFR are sparse in this population.Methods:We evaluated cross-sectional and longitudinal accuracy and bias of eGFR, based on creatinine and cystatin C, relative to disappearance of infused iohexol from plasma (iGFR) in a cohort of participants followed annually for up to 7 years.Results:A total of 222 HIV-positive and 139 HIV-negative participants contributed 1240 visits with valid iGFR and eGFR measures. Estimated GFR based on both creatinine and cystatin C performed the best. Estimated GFR based on creatinine alone overestimated iGFR by 9 mL·min·1.73 m-2on average and was significantly less accurate in HIV-positive than HIV-negative individuals. The performance of equations based on either creatinine alone or cystatin C alone were significantly affected by participant factors (eg, non-suppressed HIV RNA, nadir CD4 count, hepatitis C virus coinfection). The average iGFR slope was-4% per year in HIV-positive participants. In both HIV-positive and HIV-negative participants, eGFR slope measures were generally unbiased but inaccurate, with only 60%-74% of observations falling within ±5% points of iGFR slope.Conclusions:Both creatinine and cystatin C have limitations as GFR indices in HIV-positive individuals. Estimated GFR based on both creatinine and cystatin C performed best in our study and may be preferred in HIV-positive persons with kidney disease or comorbidities that place them at high risk for kidney disease.

Original languageEnglish (US)
Pages (from-to)E58-E66
JournalJournal of Acquired Immune Deficiency Syndromes
Volume85
Issue number4
DOIs
StatePublished - Dec 1 2020

Keywords

  • Chronic kidney disease
  • Creatinine
  • Cystatin C
  • Glomerular filtration rate
  • HIV-1
  • Hepatitis C virus

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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