Performance of creatinine and cystatin C GFR estimating equations in an HIV-positive population on antiretrovirals.

Journal Article (Journal Article)

OBJECTIVE: To evaluate the performance of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine, cystatin C, and creatinine-cystatin C estimating equations in HIV-positive patients. METHODS: We evaluated the performance of the Modification of Diet in Renal Disease (MDRD) Study and CKD-EPI creatinine 2009, CKD-EPI cystatin C 2012, and CKD-EPI creatinine-cystatin C 2012 glomerular filtration rate (GFR) estimating equations compared with GFR measured using plasma clearance of iohexol in 200 HIV-positive patients on stable antiretroviral therapy. Creatinine and cystatin C assays were standardized to certified reference materials. RESULTS: Of the 200 participants, median (IQR) CD4 count was 536 (421) and 61% had an undetectable HIV viral load. Mean (SD) measured GFR (mGFR) was 87 (26) mL/min per 1.73 m. All CKD-EPI equations performed better than the MDRD Study equation. All 3 CKD-EPI equations had similar bias and precision. The cystatin C equation was not more accurate than the creatinine equation. The creatinine-cystatin C equation was significantly more accurate than the cystatin C equation, and there was a trend toward greater accuracy than the creatinine equation. Accuracy was equal or better in most subgroups with the combined equation compared to either alone. CONCLUSIONS: The CKD-EPI cystatin C equation does not seem to be more accurate than the CKD-EPI creatinine equation in patients who are HIV-positive, supporting the use of the CKD-EPI creatinine equation for routine clinical care for use in North American populations with HIV. The use of both filtration markers together as a confirmatory test for decreased estimated GFR based on creatinine in individuals who are HIV-positive requires further study.

Full Text

Duke Authors

Cited Authors

  • Inker, LA; Wyatt, C; Creamer, R; Hellinger, J; Hotta, M; Leppo, M; Levey, AS; Okparavero, A; Graham, H; Savage, K; Schmid, CH; Tighiouart, H; Wallach, F; Krishnasami, Z

Published Date

  • November 1, 2012

Published In

Volume / Issue

  • 61 / 3

Start / End Page

  • 302 - 309

PubMed ID

  • 22842844

Pubmed Central ID

  • PMC3598619

Electronic International Standard Serial Number (EISSN)

  • 1944-7884

Digital Object Identifier (DOI)

  • 10.1097/QAI.0b013e31826a6c4f


  • eng

Conference Location

  • United States