Estimating kidney function in HIV-infected adults in Kenya: comparison to a direct measure of glomerular filtration rate by iohexol clearance.
Estimating kidney function in HIV-infected adults in Kenya: comparison to a direct measure of glomerular filtration rate by iohexol clearance.
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DOI：
10.1371/journal.pone.0069601
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Wools-Kaloustian K
中科院分区：
文献类型：
--
作者：
Wyatt CM;Schwartz GJ;Owino Ong'or W;Abuya J;Abraham AG;Mboku C;M'mene LB;Koima WJ;Hotta M;Maier P;Klotman PE;Wools-Kaloustian K
世界上超过三分之二的艾滋病毒阳性个体生活在撒哈拉以南非洲，那里对肾脏疾病的遗传易感性很高，肾脏疾病筛查和抗逆转录病毒治疗（ART）毒性监测的资源有限。根据血清肌酐估算肾小球滤过率（GFR）的公式是在西方人群中推导出来的，在这些人群中可能不太准确。我们将发表的GFR估计方程的结果与99名hiv感染的ART-naïve肯尼亚成年人通过碘己醇清除率直接测量的GFR进行了比较。用滤纸上的干血点测定碘己醇浓度。计算偏倚比（估计值与实际GFR之比的平均值）和准确度（估计值在实际GFR的30%以内的百分比）。中位年龄为35岁，60%为女性。大多数无症状HIV，中位CD4+细胞计数为355个细胞/mm3。GFR中位数为115 mL/min/1.73 m2。慢性肾脏疾病流行病学联盟（CKD-EPI）方程的总体准确性最高。与先前的报告一致，通过消除黑人系数（在测量GFR的30%内估计的85%），偏差和准确性得到了改善。在GFR为60-90 mL/min/1.73 m2的参与者中，所有方程的准确性都很差（在GFR测量值的30%内<估计值的65%），尽管该亚组太小，无法得出明确的结论。CKD-EPI方程的总体准确性最高。消除比赛系数进一步提高了性能。对于GFR <90 mL/min/1.73 m2的患者，需要进一步的研究来确定最准确的GFR估计值，在这些患者中，准确的肾功能估计值对指导给药很重要。在资源有限的环境中，通过使用滤纸法通过碘醇清除率直接测量GFR对于研究目的是可行的，并且可以用于在非洲人群中制定更准确的GFR估计。
More than two-thirds of the world's HIV-positive individuals live in sub-Saharan Africa, where genetic susceptibility to kidney disease is high and resources for kidney disease screening and antiretroviral therapy (ART) toxicity monitoring are limited. Equations to estimate glomerular filtration rate (GFR) from serum creatinine were derived in Western populations and may be less accurate in this population. We compared results from published GFR estimating equations with a direct measure of GFR by iohexol clearance in 99 HIV-infected, ART-naïve Kenyan adults. Iohexol concentration was measured from dried blood spots on filter paper. The bias ratio (mean of the ratio of estimated to measured GFR) and accuracy (percentage of estimates within 30% of the measured GFR) were calculated. The median age was 35 years, and 60% were women. The majority had asymptomatic HIV, with median CD4+ cell count of 355 cells/mm3. Median measured GFR was 115 mL/min/1.73 m2. Overall accuracy was highest for the Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation. Consistent with a prior report, bias and accuracy were improved by eliminating the coefficient for black race (85% of estimates within 30% of measured GFR). Accuracy of all equations was poor in participants with GFR 60–90 mL/min/1.73 m2 (<65% of estimates within 30% of measured GFR), although this subgroup was too small to reach definitive conclusions. Overall accuracy was highest for the CKD-EPI equation. Eliminating the coefficient for race further improved performance. Future studies are needed to determine the most accurate GFR estimate for use in individuals with GFR <90 mL/min/1.73 m2, in whom accurate estimation of kidney function is important to guide drug dosing. Direct measurement of GFR by iohexol clearance using a filter paper based assay is feasible for research purposes in resource-limited settings, and could be used to develop more accurate GFR estimates in African populations.
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DOI：
10.1126/science.1193032
发表时间：
2010-08-13
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Genovese G;Friedman DJ;Ross MD;Lecordier L;Uzureau P;Freedman BI;Bowden DW;Langefeld CD;Oleksyk TK;Uscinski Knob AL;Bernhardy AJ;Hicks PJ;Nelson GW;Vanhollebeke B;Winkler CA;Kopp JB;Pays E;Pollak MR
通讯作者：
Pollak MR
影响因子：
30.8
作者：
Kopp, Jeffrey B.;Smith, Michael W.;Nelson, George W.;Johnson, Randall C.;Freedman, Barry I.;Bowden, Donald W.;Oleksyk, Taras;McKenzie, Louise M.;Kajiyama, Hiroshi;Ahuja, Tejinder S.;Berns, Jeffrey S.;Briggs, William;Cho, Monique E.;Dart, Richard A.;Kimmel, Paul L.;Korbet, Stephen M.;Michel, Donna M.;Mokrzycki, Michele H.;Schelling, Jeffrey R.;Simon, Eric;Trachtman, Howard;Vlahov, David;Winkler, Cheryl A.
通讯作者：
Winkler, Cheryl A.
DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
影响因子：
3.8
作者：
Mocroft, Amanda;Kirk, Ole;Lundgren, Jens D.
通讯作者：
Lundgren, Jens D.
DOI：
10.1097/qai.0b013e31826a6c4f
发表时间：
2012-11-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
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
通讯作者：
Krishnasami Z