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

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18 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Driver, T. H., Scherzer, R., Peralta, C. A., Tien, P. C., Estrella, M. M., Parikh, C. R., Butch, A. W., Anastos, K., Cohen, M. H., Nowicki, M., Sharma, A., Young, M. A., Abraham, A., & 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