Chronic kidney disease and estimates of kidney function in HIV infection: A cross-sectional study in the multicenter AIDS cohort study

Michelle M. Estrella*, Rulan S. Parekh, Brad C. Astor, Robert Bolan, Rhobert W. Evans, Frank J. Palella, Lisa P. Jacobson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Background: Cystatin C has been proposed as an alternative marker of kidney function among HIV-infected persons in whom serum creatinine is affected by extrarenal factors. Methods: In this cross-sectional study, we compared estimated glomerular filtration rates (eGFR) using serum creatinine versus cystatin C between 150 HIV-uninfected and 783 HIV-infected men. We evaluated the prevalence of chronic kidney disease (CKD; eGFR less than 60 mL/min/1.73 m) and examined the influence of extrarenal factors on GFR estimates among HIV-infected men. RESULTS:: Estimated GFRSCR was similar by HIV serostatus, but eGFRCYSC was lower in HIV-infected men. A higher proportion of HIV-infected men were classified as having CKD when using eGFRCYSC versus eGFRSCR (7% vs 5%, P < 0.01). In HIV-infected individuals without CKD, eGFRSCR was higher than eGFRCYSC, whereas it was lower than eGFRCYSC in persons with CKD. In HIV-infected men, older age, proteinuria, and prior clinical AIDS were inversely associated with both GFR estimates. Higher serum albumin levels and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use were associated with lower eGFRSCR. HIV viral load, hepatitis C coinfection, and serum alkaline phosphatase were inversely associated with eGFRCYSC. Conclusion: Among HIV-uninfected and HIV-infected men of similar social risk behaviors, GFR estimates differed by biomarker and kidney function level. Estimated GFRCYSC classified a larger proportion of HIV-infected men with CKD compared with eGFRSCR. Differences between these GFR-estimating methods may be the result of the effects of extrarenal factors on serum creatinine and cystatin C. Until GFR-estimating equations are validated among HIV-infected individuals, current GFR estimates based on these biomarkers should be interpreted with care in this patient population.

Original languageEnglish (US)
Pages (from-to)380-386
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume57
Issue number5
DOIs
StatePublished - Aug 15 2011

Keywords

  • HIV
  • Multicenter AIDS Cohort Study
  • cystatin C
  • glomerular filtration rate
  • kidney disease
  • serum creatinine

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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