Isnard Bagnis Corinne, Pieroni Laurence, Inaoui Rachida, Maksud Philippe, Lallauret Stéphanie, Valantin Marc-Antoine, Tubiana Roland, Katlama Christine, Deray Gilbert, Courbebaisse Marie, Tourret Jérôme, Tezenas du Montcel Sophie
Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France.
Biochemistry Department, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France.
PLoS One. 2017 Nov 2;12(11):e0186410. doi: 10.1371/journal.pone.0186410. eCollection 2017.
Chronic kidney disease is a frequent complication in persons living with HIV/AIDS. Although previous studies have suggested that the CKD-EPI formula is appropriate to estimate glomerular filtration rate (GFR) in HIV-positive adults with normal kidney function, the optimal way to estimate GFR in those with Stage 3 chronic kidney disease is not known. Moreover, the impact of muscle mass on creatinine level and GFR estimation is unknown.
Our study aimed to evaluate the accuracy of different diagnostic tests available compared to the gold standard measurement of GFR. A group of 44 HIV-1 patients with an estimated GFR between 60 and 30 ml/min/1.73 m2 were included in a single-center cross-sectional study. Serum creatinine and cystatin C were measured. GFR was estimated using Cockcroft-Gault, MDRD, sMDRD, CKD-EPI, CKD-EPIcyst, and CKD-EPIcyst/creat formulae and was measured using isotopic Chrome51 EDTA clearance. Bone density and muscle mass were measured by DXA scan.
Mean age was 62±10 years. Mean BMI was 23±4 kg/m2. Prevalence of diabetes was 30% and of hypertension was 47%. Viral load was <40 copies/ml for 90% of the patients, and mean CD4 count was 446±191 cells/mm3. Mean measured GFR was 63.4±16.5 ml/min/1.73 m2. All formulae under-estimated GFR. The best relative precision and accuracy were provided by the CKP-EPI formula. sMDRD, CKD-EPIcyst, and CKD-EPIcyst/creat performed worse than the CKD-EPI formula. Body composition did not significantly influence accuracy or precision of GFR estimation.
In HIV-infected patients in stable immunovirologic conditions with CKD stage 3 and high prevalence of metabolic associated conditions, the CKD-EPI formula performed best, although all formulae under estimate GFR.
慢性肾脏病是人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）患者常见的并发症。尽管先前的研究表明，CKD-EPI公式适用于估算肾功能正常的HIV阳性成年人的肾小球滤过率（GFR），但对于估算3期慢性肾脏病患者GFR的最佳方法尚不清楚。此外，肌肉量对肌酐水平和GFR估算的影响也未知。
我们的研究旨在评估与GFR的金标准测量相比，现有不同诊断测试的准确性。一组44例估算GFR在60至30 ml/min/1.73 m²之间的HIV-1患者纳入一项单中心横断面研究。测量血清肌酐和胱抑素C。使用Cockcroft-Gault、MDRD、sMDRD、CKD-EPI、CKD-EPIcyst和CKD-EPIcyst/creat公式估算GFR，并使用同位素铬51标记的乙二胺四乙酸（Chrome51 EDTA）清除率测量GFR。通过双能X线吸收法（DXA）扫描测量骨密度和肌肉量。
平均年龄为62±10岁。平均体重指数（BMI）为23±4 kg/m²。糖尿病患病率为30%，高血压患病率为47%。90%的患者病毒载量<40拷贝/ml，平均CD4细胞计数为446±191个/mm³。平均测量的GFR为63.4±16.5 ml/min/1.73 m²。所有公式均低估了GFR。CKP-EPI公式提供了最佳的相对精度和准确性。sMDRD、CKD-EPIcyst和CKD-EPIcyst/creat的表现比CKD-EPI公式差。身体组成对GFR估算的准确性或精度没有显著影响。
在免疫病毒学状态稳定、患有3期慢性肾脏病且代谢相关疾病患病率高的HIV感染患者中，CKD-EPI公式表现最佳，尽管所有公式均低估了GFR。
