Glomerular filtration rate estimated using creatinine, cystatin C or both markers and the risk of clinical events in HIV-infected individuals

G. M. Lucas, A. Cozzi-Lepri, C. M. Wyatt, F. A. Post, A. M. Bormann, N. F. Crum-Cianflone, Michael J. Ross

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives: The accuracy and precision of glomerular filtration rate (GFR) estimating equations based on plasma creatinine (GFRcr), cystatin C (GFRcys) and the combination of these markers (GFRcr-cys) have recently been assessed in HIV-infected individuals. We assessed the associations of GFR, estimated by these three equations, with clinical events in HIV-infected individuals. Methods: We compared the associations of baseline GFRcr, GFRcys and GFRcr-cys [using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations] with mortality, cardiovascular events (CVEs) and opportunistic diseases (ODs) in the Strategies for the Management of Antiretroviral Therapy (SMART) study. We used Cox proportional hazards models to estimate unadjusted and adjusted hazard ratios per standard deviation (SD) change in GFR. Results: A total of 4614 subjects from the SMART trial with available baseline creatinine and cystatin C data were included in this analysis. Of these, 99 died, 111 had a CVE and 121 had an OD. GFRcys was weakly to moderately correlated with HIV RNA, CD4 cell count, high-sensitivity C-reactive protein, interleukin-6, and D-dimer, while GFRcr had little or no correlation with these factors. GFRcys had the strongest associations with the three clinical outcomes, followed closely by GFRcr-cys, with GFRcr having the weakest associations with clinical outcomes. In a model adjusting for demographics, cardiovascular risk factors, HIV-related factors and inflammation markers, a 1-SD lower GFRcys was associated with a 55% [95% confidence interval (CI) 27-90%] increased risk of mortality, a 21% (95% CI 0-47%) increased risk of CVE, and a 22% (95% CI 0-48%) increased risk of OD. Conclusions: Of the three CKD-EPI GFR equations, GFRcys had the strongest associations with mortality, CVE and OD.

Original languageEnglish (US)
Pages (from-to)116-123
Number of pages8
JournalHIV Medicine
Volume15
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Cystatin C
Glomerular Filtration Rate
Creatinine
Biomarkers
HIV
Confidence Intervals
Chronic Renal Insufficiency
Mortality
Epidemiology
CD4 Lymphocyte Count
Proportional Hazards Models
C-Reactive Protein
Interleukin-6
Demography
RNA
Inflammation
Therapeutics

Keywords

  • Cardiovascular disease
  • Creatinine
  • Cystatin C
  • Glomerular filtration rate
  • HIV-1
  • Mortality
  • Opportunistic disease

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Health Policy

Cite this

Glomerular filtration rate estimated using creatinine, cystatin C or both markers and the risk of clinical events in HIV-infected individuals. / Lucas, G. M.; Cozzi-Lepri, A.; Wyatt, C. M.; Post, F. A.; Bormann, A. M.; Crum-Cianflone, N. F.; Ross, Michael J.

In: HIV Medicine, Vol. 15, No. 2, 02.2014, p. 116-123.

Research output: Contribution to journalArticle

Lucas, G. M. ; Cozzi-Lepri, A. ; Wyatt, C. M. ; Post, F. A. ; Bormann, A. M. ; Crum-Cianflone, N. F. ; Ross, Michael J. / Glomerular filtration rate estimated using creatinine, cystatin C or both markers and the risk of clinical events in HIV-infected individuals. In: HIV Medicine. 2014 ; Vol. 15, No. 2. pp. 116-123.
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abstract = "Objectives: The accuracy and precision of glomerular filtration rate (GFR) estimating equations based on plasma creatinine (GFRcr), cystatin C (GFRcys) and the combination of these markers (GFRcr-cys) have recently been assessed in HIV-infected individuals. We assessed the associations of GFR, estimated by these three equations, with clinical events in HIV-infected individuals. Methods: We compared the associations of baseline GFRcr, GFRcys and GFRcr-cys [using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations] with mortality, cardiovascular events (CVEs) and opportunistic diseases (ODs) in the Strategies for the Management of Antiretroviral Therapy (SMART) study. We used Cox proportional hazards models to estimate unadjusted and adjusted hazard ratios per standard deviation (SD) change in GFR. Results: A total of 4614 subjects from the SMART trial with available baseline creatinine and cystatin C data were included in this analysis. Of these, 99 died, 111 had a CVE and 121 had an OD. GFRcys was weakly to moderately correlated with HIV RNA, CD4 cell count, high-sensitivity C-reactive protein, interleukin-6, and D-dimer, while GFRcr had little or no correlation with these factors. GFRcys had the strongest associations with the three clinical outcomes, followed closely by GFRcr-cys, with GFRcr having the weakest associations with clinical outcomes. In a model adjusting for demographics, cardiovascular risk factors, HIV-related factors and inflammation markers, a 1-SD lower GFRcys was associated with a 55{\%} [95{\%} confidence interval (CI) 27-90{\%}] increased risk of mortality, a 21{\%} (95{\%} CI 0-47{\%}) increased risk of CVE, and a 22{\%} (95{\%} CI 0-48{\%}) increased risk of OD. Conclusions: Of the three CKD-EPI GFR equations, GFRcys had the strongest associations with mortality, CVE and OD.",
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T1 - Glomerular filtration rate estimated using creatinine, cystatin C or both markers and the risk of clinical events in HIV-infected individuals

AU - Lucas, G. M.

AU - Cozzi-Lepri, A.

AU - Wyatt, C. M.

AU - Post, F. A.

AU - Bormann, A. M.

AU - Crum-Cianflone, N. F.

AU - Ross, Michael J.

PY - 2014/2

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N2 - Objectives: The accuracy and precision of glomerular filtration rate (GFR) estimating equations based on plasma creatinine (GFRcr), cystatin C (GFRcys) and the combination of these markers (GFRcr-cys) have recently been assessed in HIV-infected individuals. We assessed the associations of GFR, estimated by these three equations, with clinical events in HIV-infected individuals. Methods: We compared the associations of baseline GFRcr, GFRcys and GFRcr-cys [using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations] with mortality, cardiovascular events (CVEs) and opportunistic diseases (ODs) in the Strategies for the Management of Antiretroviral Therapy (SMART) study. We used Cox proportional hazards models to estimate unadjusted and adjusted hazard ratios per standard deviation (SD) change in GFR. Results: A total of 4614 subjects from the SMART trial with available baseline creatinine and cystatin C data were included in this analysis. Of these, 99 died, 111 had a CVE and 121 had an OD. GFRcys was weakly to moderately correlated with HIV RNA, CD4 cell count, high-sensitivity C-reactive protein, interleukin-6, and D-dimer, while GFRcr had little or no correlation with these factors. GFRcys had the strongest associations with the three clinical outcomes, followed closely by GFRcr-cys, with GFRcr having the weakest associations with clinical outcomes. In a model adjusting for demographics, cardiovascular risk factors, HIV-related factors and inflammation markers, a 1-SD lower GFRcys was associated with a 55% [95% confidence interval (CI) 27-90%] increased risk of mortality, a 21% (95% CI 0-47%) increased risk of CVE, and a 22% (95% CI 0-48%) increased risk of OD. Conclusions: Of the three CKD-EPI GFR equations, GFRcys had the strongest associations with mortality, CVE and OD.

AB - Objectives: The accuracy and precision of glomerular filtration rate (GFR) estimating equations based on plasma creatinine (GFRcr), cystatin C (GFRcys) and the combination of these markers (GFRcr-cys) have recently been assessed in HIV-infected individuals. We assessed the associations of GFR, estimated by these three equations, with clinical events in HIV-infected individuals. Methods: We compared the associations of baseline GFRcr, GFRcys and GFRcr-cys [using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations] with mortality, cardiovascular events (CVEs) and opportunistic diseases (ODs) in the Strategies for the Management of Antiretroviral Therapy (SMART) study. We used Cox proportional hazards models to estimate unadjusted and adjusted hazard ratios per standard deviation (SD) change in GFR. Results: A total of 4614 subjects from the SMART trial with available baseline creatinine and cystatin C data were included in this analysis. Of these, 99 died, 111 had a CVE and 121 had an OD. GFRcys was weakly to moderately correlated with HIV RNA, CD4 cell count, high-sensitivity C-reactive protein, interleukin-6, and D-dimer, while GFRcr had little or no correlation with these factors. GFRcys had the strongest associations with the three clinical outcomes, followed closely by GFRcr-cys, with GFRcr having the weakest associations with clinical outcomes. In a model adjusting for demographics, cardiovascular risk factors, HIV-related factors and inflammation markers, a 1-SD lower GFRcys was associated with a 55% [95% confidence interval (CI) 27-90%] increased risk of mortality, a 21% (95% CI 0-47%) increased risk of CVE, and a 22% (95% CI 0-48%) increased risk of OD. Conclusions: Of the three CKD-EPI GFR equations, GFRcys had the strongest associations with mortality, CVE and OD.

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KW - Creatinine

KW - Cystatin C

KW - Glomerular filtration rate

KW - HIV-1

KW - Mortality

KW - Opportunistic disease

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