Comparisons of creatinine and cystatin C for detection of kidney disease and prediction of all-cause mortality in HIV-infected women

Todd H. Driver, Rebecca Scherzer, Carmen A. Peralta, Phyllis C. Tien, Michelle M. Estrella, Chirag R. Parikh, Anthony W. Butch, Kathryn Anastos, Mardge H. Cohen, Marek Nowicki, Anjali Sharma, Mary A. Young, Alison Abraham, Michael G. Shlipak

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Cystatin C could improve chronic kidney disease (CKD) classification in HIV-infected women relative to serum creatinine. Design: Retrospective cohort analysis. Methods: Cystatin C and creatinine were measured from specimens taken and stored during the 1999-2000 examination among 908 HIV-infected participants in the Women's Interagency HIV study (WIHS). Mean follow-up was 10.2 years. Predictors of differential glomerular filtration rate (GFR) estimates were evaluated with multivariable linear regression. The associations of baseline categories (<60, 60-90, and >90 ml/min per 1.73m2) of creatinine estimated GFR (eGFRcr), cystatin C eGFR (eGFRcys), and combined creatinine-cystatin C eGFR (eGFR cr-cys) with all-cause mortality were evaluated using multivariable Cox regression. The net reclassification index (NRI) was calculated to evaluate the effect of cystatin C on reclassification of CKD staging. Results: CKD risk factors were associated with lower eGFRcys and eGFRcr-cys values compared with eGFRcr. Relative to eGFR more than 90, the eGFR less than 60 category by eGFRcys (Adjusted hazard ratio: 2.56; 95% confidence interval: 1.63-4.02), eGFRcr-cys (3.11; 1.94-5.00), and eGFRcr (2.34; 1.44-3.79) was associated with increased mortality risk. However, the eGFR 60-90 category was associated with increased mortality risk for eGFRcys (1.80; 1.28-2.53) and eGFRcr-cys (1.91; 1.38-2.66) but not eGFRcr (1.20; 0.85-1.67). The overall NRI for mortality was 26% when reclassifying from eGFRcr to eGFR cys (P<0.001) and was 20% when reclassifying from eGFR cr to eGFRcr-cys (P<0.001). Conclusion: The addition of cystatin C may improve mortality risk prediction by stages of kidney function relative to creatinine. CKD risk factors are associated with an overestimate of GFR by serum creatinine relative to cystatin C.

Original languageEnglish (US)
Pages (from-to)2291-2299
Number of pages9
JournalAIDS
Volume27
Issue number14
DOIs
StatePublished - Sep 10 2013

Fingerprint

Cystatin C
Kidney Diseases
Creatinine
HIV
Mortality
Chronic Renal Insufficiency
Glomerular Filtration Rate
Serum
Linear Models
Cohort Studies
Confidence Intervals
Kidney

Keywords

  • Creatinine
  • Cystatin C
  • Glomerular filtration rate
  • HIV
  • Kidney
  • Mortality
  • Women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Driver, T. H., Scherzer, R., Peralta, C. A., Tien, P. C., Estrella, M. M., Parikh, C. R., ... Shlipak, M. G. (2013). Comparisons of creatinine and cystatin C for detection of kidney disease and prediction of all-cause mortality in HIV-infected women. AIDS, 27(14), 2291-2299. https://doi.org/10.1097/QAD.0b013e328362e874

Comparisons of creatinine and cystatin C for detection of kidney disease and prediction of all-cause mortality in HIV-infected women. / Driver, Todd H.; Scherzer, Rebecca; Peralta, Carmen A.; Tien, Phyllis C.; Estrella, Michelle M.; Parikh, Chirag R.; Butch, Anthony W.; Anastos, Kathryn; Cohen, Mardge H.; Nowicki, Marek; Sharma, Anjali; Young, Mary A.; Abraham, Alison; Shlipak, Michael G.

In: AIDS, Vol. 27, No. 14, 10.09.2013, p. 2291-2299.

Research output: Contribution to journalArticle

Driver, TH, Scherzer, R, Peralta, CA, Tien, PC, Estrella, MM, Parikh, CR, Butch, AW, Anastos, K, Cohen, MH, Nowicki, M, Sharma, A, Young, MA, Abraham, A & Shlipak, MG 2013, 'Comparisons of creatinine and cystatin C for detection of kidney disease and prediction of all-cause mortality in HIV-infected women', AIDS, vol. 27, no. 14, pp. 2291-2299. https://doi.org/10.1097/QAD.0b013e328362e874
Driver, Todd H. ; Scherzer, Rebecca ; Peralta, Carmen A. ; Tien, Phyllis C. ; Estrella, Michelle M. ; Parikh, Chirag R. ; Butch, Anthony W. ; Anastos, Kathryn ; Cohen, Mardge H. ; Nowicki, Marek ; Sharma, Anjali ; Young, Mary A. ; Abraham, Alison ; Shlipak, Michael G. / Comparisons of creatinine and cystatin C for detection of kidney disease and prediction of all-cause mortality in HIV-infected women. In: AIDS. 2013 ; Vol. 27, No. 14. pp. 2291-2299.
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abstract = "Background: Cystatin C could improve chronic kidney disease (CKD) classification in HIV-infected women relative to serum creatinine. Design: Retrospective cohort analysis. Methods: Cystatin C and creatinine were measured from specimens taken and stored during the 1999-2000 examination among 908 HIV-infected participants in the Women's Interagency HIV study (WIHS). Mean follow-up was 10.2 years. Predictors of differential glomerular filtration rate (GFR) estimates were evaluated with multivariable linear regression. The associations of baseline categories (<60, 60-90, and >90 ml/min per 1.73m2) of creatinine estimated GFR (eGFRcr), cystatin C eGFR (eGFRcys), and combined creatinine-cystatin C eGFR (eGFR cr-cys) with all-cause mortality were evaluated using multivariable Cox regression. The net reclassification index (NRI) was calculated to evaluate the effect of cystatin C on reclassification of CKD staging. Results: CKD risk factors were associated with lower eGFRcys and eGFRcr-cys values compared with eGFRcr. Relative to eGFR more than 90, the eGFR less than 60 category by eGFRcys (Adjusted hazard ratio: 2.56; 95{\%} confidence interval: 1.63-4.02), eGFRcr-cys (3.11; 1.94-5.00), and eGFRcr (2.34; 1.44-3.79) was associated with increased mortality risk. However, the eGFR 60-90 category was associated with increased mortality risk for eGFRcys (1.80; 1.28-2.53) and eGFRcr-cys (1.91; 1.38-2.66) but not eGFRcr (1.20; 0.85-1.67). The overall NRI for mortality was 26{\%} when reclassifying from eGFRcr to eGFR cys (P<0.001) and was 20{\%} when reclassifying from eGFR cr to eGFRcr-cys (P<0.001). Conclusion: The addition of cystatin C may improve mortality risk prediction by stages of kidney function relative to creatinine. CKD risk factors are associated with an overestimate of GFR by serum creatinine relative to cystatin C.",
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author = "Driver, {Todd H.} and Rebecca Scherzer and Peralta, {Carmen A.} and Tien, {Phyllis C.} and Estrella, {Michelle M.} and Parikh, {Chirag R.} and Butch, {Anthony W.} and Kathryn Anastos and Cohen, {Mardge H.} and Marek Nowicki and Anjali Sharma and Young, {Mary A.} and Alison Abraham and Shlipak, {Michael G.}",
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TY - JOUR

T1 - Comparisons of creatinine and cystatin C for detection of kidney disease and prediction of all-cause mortality in HIV-infected women

AU - Driver, Todd H.

AU - Scherzer, Rebecca

AU - Peralta, Carmen A.

AU - Tien, Phyllis C.

AU - Estrella, Michelle M.

AU - Parikh, Chirag R.

AU - Butch, Anthony W.

AU - Anastos, Kathryn

AU - Cohen, Mardge H.

AU - Nowicki, Marek

AU - Sharma, Anjali

AU - Young, Mary A.

AU - Abraham, Alison

AU - Shlipak, Michael G.

PY - 2013/9/10

Y1 - 2013/9/10

N2 - Background: Cystatin C could improve chronic kidney disease (CKD) classification in HIV-infected women relative to serum creatinine. Design: Retrospective cohort analysis. Methods: Cystatin C and creatinine were measured from specimens taken and stored during the 1999-2000 examination among 908 HIV-infected participants in the Women's Interagency HIV study (WIHS). Mean follow-up was 10.2 years. Predictors of differential glomerular filtration rate (GFR) estimates were evaluated with multivariable linear regression. The associations of baseline categories (<60, 60-90, and >90 ml/min per 1.73m2) of creatinine estimated GFR (eGFRcr), cystatin C eGFR (eGFRcys), and combined creatinine-cystatin C eGFR (eGFR cr-cys) with all-cause mortality were evaluated using multivariable Cox regression. The net reclassification index (NRI) was calculated to evaluate the effect of cystatin C on reclassification of CKD staging. Results: CKD risk factors were associated with lower eGFRcys and eGFRcr-cys values compared with eGFRcr. Relative to eGFR more than 90, the eGFR less than 60 category by eGFRcys (Adjusted hazard ratio: 2.56; 95% confidence interval: 1.63-4.02), eGFRcr-cys (3.11; 1.94-5.00), and eGFRcr (2.34; 1.44-3.79) was associated with increased mortality risk. However, the eGFR 60-90 category was associated with increased mortality risk for eGFRcys (1.80; 1.28-2.53) and eGFRcr-cys (1.91; 1.38-2.66) but not eGFRcr (1.20; 0.85-1.67). The overall NRI for mortality was 26% when reclassifying from eGFRcr to eGFR cys (P<0.001) and was 20% when reclassifying from eGFR cr to eGFRcr-cys (P<0.001). Conclusion: The addition of cystatin C may improve mortality risk prediction by stages of kidney function relative to creatinine. CKD risk factors are associated with an overestimate of GFR by serum creatinine relative to cystatin C.

AB - Background: Cystatin C could improve chronic kidney disease (CKD) classification in HIV-infected women relative to serum creatinine. Design: Retrospective cohort analysis. Methods: Cystatin C and creatinine were measured from specimens taken and stored during the 1999-2000 examination among 908 HIV-infected participants in the Women's Interagency HIV study (WIHS). Mean follow-up was 10.2 years. Predictors of differential glomerular filtration rate (GFR) estimates were evaluated with multivariable linear regression. The associations of baseline categories (<60, 60-90, and >90 ml/min per 1.73m2) of creatinine estimated GFR (eGFRcr), cystatin C eGFR (eGFRcys), and combined creatinine-cystatin C eGFR (eGFR cr-cys) with all-cause mortality were evaluated using multivariable Cox regression. The net reclassification index (NRI) was calculated to evaluate the effect of cystatin C on reclassification of CKD staging. Results: CKD risk factors were associated with lower eGFRcys and eGFRcr-cys values compared with eGFRcr. Relative to eGFR more than 90, the eGFR less than 60 category by eGFRcys (Adjusted hazard ratio: 2.56; 95% confidence interval: 1.63-4.02), eGFRcr-cys (3.11; 1.94-5.00), and eGFRcr (2.34; 1.44-3.79) was associated with increased mortality risk. However, the eGFR 60-90 category was associated with increased mortality risk for eGFRcys (1.80; 1.28-2.53) and eGFRcr-cys (1.91; 1.38-2.66) but not eGFRcr (1.20; 0.85-1.67). The overall NRI for mortality was 26% when reclassifying from eGFRcr to eGFR cys (P<0.001) and was 20% when reclassifying from eGFR cr to eGFRcr-cys (P<0.001). Conclusion: The addition of cystatin C may improve mortality risk prediction by stages of kidney function relative to creatinine. CKD risk factors are associated with an overestimate of GFR by serum creatinine relative to cystatin C.

KW - Creatinine

KW - Cystatin C

KW - Glomerular filtration rate

KW - HIV

KW - Kidney

KW - Mortality

KW - Women

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