Performance of creatinine and cystatin C GFR estimating equations in an HIV-positive population on antiretrovirals.
Performance of creatinine and cystatin C GFR estimating equations in an HIV-positive population on antiretrovirals.
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DOI：
10.1097/qai.0b013e31826a6c4f
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发表时间：
2012-11-01
期刊：
影响因子：
--
通讯作者：
Krishnasami Z
中科院分区：
文献类型：
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作者：
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
评价hiv阳性患者CKD-EPI肌酐、胱抑素C和肌酐-胱抑素C估计方程的性能。我们评估了MDRD研究和CKD-EPI肌酐2009、CKD-EPI胱抑素C 2012和CKD-EPI肌酐-胱抑素C 2012肾小球滤过率（GFR）估算方程的性能，并将其与200名接受稳定抗逆转录病毒治疗的hiv阳性患者血浆碘醇清除率测量的GFR进行比较。肌酐和胱抑素C测定标准化为认证的参考物质。在200名参与者中，中位数（IQR） CD4计数为536(421)，61%的人无法检测到hiv病毒载量。平均（SD）测量GFR （mGFR）为87 (26)ml/min/1.73m2。所有CKD-EPI方程都优于MDRD研究方程。所有三个CKD-EPI方程具有相似的偏差和精度。胱抑素C方程并不比肌酐方程更准确。肌酐-胱抑素C方程的准确性显著高于胱抑素C方程，并有高于肌酐方程的趋势。在大多数亚组中，与单独使用任何一种方法相比，使用联合方程的准确性相同或更好。在HIV阳性患者中，CKD-EPI胱抑素C方程似乎并不比CKD-EPI肌酐方程更准确，这支持将CKD-EPI肌酐方程用于北美HIV感染者的常规临床护理。使用这两种过滤标记物一起作为hiv阳性个体基于肌酐估计GFR下降的确证试验需要进一步的研究。
To evaluate the performance of CKD-EPI creatinine, cystatin C and creatinine-cystatin C estimating equations in HIV-positive patients. We evaluated the performance of the 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 to 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. 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/1.73m2. All CKD-EPI equations performed better than the MDRD Study equation. All three 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. The CKD-EPI cystatin C equation does not appear 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.