Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; and.
Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
J Acquir Immune Defic Syndr. 2020 Dec 1;85(4):e58-e66. doi: 10.1097/QAI.0000000000002471.
Reliable estimates of glomerular filtration rate (GFR) are important in the clinical management of HIV-positive patients. Data on the performance of widely used estimating equations (eGFR) relative to exogenously measured GFR are sparse in this population.
We evaluated cross-sectional and longitudinal accuracy and bias of eGFR, based on creatinine and cystatin C, relative to disappearance of infused iohexol from plasma (iGFR) in a cohort of participants followed annually for up to 7 years.
A total of 222 HIV-positive and 139 HIV-negative participants contributed 1240 visits with valid iGFR and eGFR measures. Estimated GFR based on both creatinine and cystatin C performed the best. Estimated GFR based on creatinine alone overestimated iGFR by 9 mL·min·1.73 m on average and was significantly less accurate in HIV-positive than HIV-negative individuals. The performance of equations based on either creatinine alone or cystatin C alone were significantly affected by participant factors (eg, non-suppressed HIV RNA, nadir CD4 count, hepatitis C virus coinfection). The average iGFR slope was -4% per year in HIV-positive participants. In both HIV-positive and HIV-negative participants, eGFR slope measures were generally unbiased but inaccurate, with only 60%-74% of observations falling within ±5% points of iGFR slope.
Both creatinine and cystatin C have limitations as GFR indices in HIV-positive individuals. Estimated GFR based on both creatinine and cystatin C performed best in our study and may be preferred in HIV-positive persons with kidney disease or comorbidities that place them at high risk for kidney disease.
在 HIV 阳性患者的临床管理中，可靠的肾小球滤过率（GFR）估计值非常重要。关于广泛使用的估算方程（eGFR）相对于外源性测量的 GFR 的表现的数据在该人群中很少。
我们评估了基于肌酐和胱抑素 C 的 eGFR 在横截面上和纵向的准确性和偏差，相对于每年随访长达 7 年的参与者群体中注入的碘海醇从血浆中消失（iGFR）。
共有 222 名 HIV 阳性和 139 名 HIV 阴性参与者共提供了 1240 次有效 iGFR 和 eGFR 测量值。基于肌酐和胱抑素 C 的 eGFR 表现最佳。仅基于肌酐的 eGFR 平均高估 iGFR 9 mL·min·1.73 m，在 HIV 阳性个体中准确性明显低于 HIV 阴性个体。仅基于肌酐或胱抑素 C 的方程的性能受到参与者因素的显著影响（例如，未抑制的 HIV RNA、最低 CD4 计数、丙型肝炎病毒合并感染）。HIV 阳性参与者的平均 iGFR 斜率为每年-4%。在 HIV 阳性和 HIV 阴性参与者中，eGFR 斜率测量值通常是无偏的，但不准确，只有 60%-74%的观察值落在 iGFR 斜率的±5%范围内。
肌酐和胱抑素 C 作为 HIV 阳性个体的 GFR 指标都有局限性。基于肌酐和胱抑素 C 的 eGFR 在我们的研究中表现最佳，可能更适合患有肾脏疾病或合并症的 HIV 阳性患者，这些疾病使他们处于肾脏疾病的高风险中。
