Department of Infectious and Tropical Diseases, CHU Hôpital Nord, Saint-Etienne, France.
AIDS. 2013 Jun 19;27(10):1573-81. doi: 10.1097/QAD.0b013e32835fac30.
To validate glomerular filtration rate (GFR) estimating equations in white HIV-infected patients based on serum creatinine and/or serum cystatin C.
Single-center, cross-sectional evaluation of the predictive performance of GFR estimators.
GFR was measured by iohexol plasma clearance. Serum creatinine (Scr) and serum cystatin C (Scyst) were measured by traceable and standardized methods. We evaluated the performance of the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations. We also studied the performance of the cystatin C-based equation (CKD-EPI Scyst) and the combined cystatin and creatinine-based equation (CKD-EPI combined), as recently proposed by the CKD-EPI group.
Two hundred and three participants (18% of women) were included. Mean age was 49 ± 10 years. Mean measured GFR (mGFR) was 95 ± 24 ml/min per 1.73 m². CKD-EPI and CKD-EPI combined significantly outperformed the MDRD equation. The percentage of estimating results within 30% of mGFR was 75, 82 and 81% for the MDRD, CKD-EPI and CKD-EPI combined equation, respectively. Results favoring the CKD-EPI and CKD-EPI combined equation were especially observed for patients with mGFR over 90 ml/min per 1.73 m².
In our European HIV cohort, we confirmed that the creatinine-based CKD-EPI equation should replace the MDRD study equation. However, global performance of this equation remains worse than the performance observed in the general population. This lesser performance is particularly relevant in patients with measured GFR under and around 60 ml/min per 1.73 m². Moreover, the specific interest of Scyst-based equations is not confirmed in this population.
基于血清肌酐和/或血清胱抑素 C 验证适用于白人 HIV 感染患者的肾小球滤过率（GFR）估算方程。
单中心、GFR 估算方程预测性能的横断面评估。
采用碘海醇血浆清除率法测定 GFR。采用可溯源和标准化方法测定血清肌酐（Scr）和血清胱抑素 C（Scyst）。我们评估了改良肾脏病饮食研究（MDRD）和慢性肾脏病流行病学合作（CKD-EPI）方程的性能。我们还研究了 CKD-EPI 小组最近提出的基于胱抑素 C 的方程（CKD-EPI Scyst）和基于胱抑素和肌酐的联合方程（CKD-EPI 联合）的性能。
共纳入 203 名参与者（18%为女性），平均年龄为 49 ± 10 岁，平均实测 GFR（mGFR）为 95 ± 24 ml/min/1.73 m²。CKD-EPI 和 CKD-EPI 联合方程显著优于 MDRD 方程。MDRD、CKD-EPI 和 CKD-EPI 联合方程估算结果在 mGFR 30%以内的比例分别为 75%、82%和 81%。对于 mGFR 超过 90 ml/min/1.73 m²的患者，CKD-EPI 和 CKD-EPI 联合方程的优势更为明显。
在我们的欧洲 HIV 队列中，我们证实基于肌酐的 CKD-EPI 方程应替代 MDRD 研究方程。然而，该方程的全球性能仍逊于在普通人群中观察到的性能。在 mGFR 为 60 ml/min/1.73 m²以下和左右的患者中，这种较差的性能尤为重要。此外，胱抑素基础方程在该人群中的特殊应用并未得到证实。
