Bhasin Bhavna, Lau Bryan, Atta Mohamed G, Fine Derek M, Estrella Michelle M, Schwartz George J, Lucas Gregory M
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America ; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2013 Dec 23;8(12):e82028. doi: 10.1371/journal.pone.0082028. eCollection 2013.
Serum creatinine and cystatin C are used as markers of glomerular filtration rate (GFR). The performance of these GFR markers relative to exogenously measured GFR (mGFR) in HIV-positive individuals is not well established.
We assessed the performance of the chronic kidney disease epidemiology collaboration equations based on serum concentrations of creatinine (eGFRcr), cystatin C (eGFRcys) and both biomarkers combined (eGFRcr-cys) in 187 HIV-positive and 98 HIV-negative participants. Measured GFR was calculated by plasma iohexol clearance. Bias and accuracy were defined as the difference between eGFR and mGFR and the percentage of eGFR observations within 30% of mGFR, respectively. Activated CD4 and CD8 T-cells (CD38+ HLA-DR+) were measured by flow cytometry.
The median mGFR was >100 ml/min/1.73 m(2) in both groups. All equations tended to be less accurate in HIV-positive than in HIV-negative subjects, with eGFRcr-cys being the most accurate overall. In the HIV-positive group, eGFRcys was significantly less accurate and more biased than eGFRcr and eGFRcr_cys. Additionally eGFRcys bias and accuracy were strongly associated with use of antiretroviral therapy, HIV RNA suppression, and percentages of activated CD4 or CD8 T-cells. Hepatitis C seropositivity was associated with larger eGFRcys bias in both HIV-positive and HIV-negative groups. In contrast, eGFRcr accuracy and bias were not associated with HIV-related factors, T-cell activation, or hepatitis C.
The performance of eGFRcys relative to mGFR was strongly correlated with HIV treatment factors and markers of T-cell activation, which may limit its usefulness as a GFR marker in this population.
血清肌酐和胱抑素C用作肾小球滤过率（GFR）的标志物。在HIV阳性个体中，这些GFR标志物相对于外源性测量的GFR（mGFR）的表现尚未完全明确。
我们评估了基于血清肌酐浓度（eGFRcr）、胱抑素C浓度（eGFRcys）以及两种生物标志物联合使用（eGFRcr-cys）的慢性肾脏病流行病学合作方程在187名HIV阳性参与者和98名HIV阴性参与者中的表现。通过血浆碘海醇清除率计算测量的GFR。偏差和准确性分别定义为eGFR与mGFR之间的差异以及eGFR观察值在mGFR的30%范围内的百分比。通过流式细胞术测量活化的CD4和CD8 T细胞（CD38+HLA-DR+）。
两组的mGFR中位数均>100 ml/min/1.73 m²。所有方程在HIV阳性受试者中往往比在HIV阴性受试者中准确性更低，总体上eGFRcr-cys最准确。在HIV阳性组中，eGFRcys的准确性明显低于eGFRcr和eGFRcr_cys，且偏差更大。此外，eGFRcys的偏差和准确性与抗逆转录病毒疗法的使用、HIV RNA抑制以及活化的CD4或CD8 T细胞百分比密切相关。丙型肝炎血清学阳性在HIV阳性和HIV阴性组中均与更大的eGFRcys偏差相关。相比之下，eGFRcr的准确性和偏差与HIV相关因素、T细胞活化或丙型肝炎无关。
eGFRcys相对于mGFR的表现与HIV治疗因素和T细胞活化标志物密切相关，这可能限制了其在该人群中作为GFR标志物的实用性。
