Abstract
Background. Renal dysfunction is common in HIV-positive patients, and guidelines suggest regular monitoring of renal function with estimated glomerular filtration rate (eGFR) and urinalysis. It is unknown whether Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) or Modification of Diet in Renal Disease (MDRD) provide better estimates of glomerular filtration rate (GFR) in this population.
Methods. We compared the CKD-EPI and MDRD equations to estimate GFR at baseline in 20 132 HIV-positive individuals in the UK CHIC cohort. Kappa statistics and Bland–Altman plots were used to assess agreement between the two estimates and Kaplan–Meier plots and Cox regression analysis to describe mortality patterns.
Results. At baseline, median eGFR was 100 (87, 112) (CKD-EPI) and 94 (83, 108) (MDRD) (mL/min/1.73m2). Good overall agreement between CKD-EPI- and MDRD-defined eGFR bands was observed (Kappa = 0.71, 95% confidence interval: 0.70–0.72). Of the 367 patients with eGFR MDRD 30–59, 57 (15.5%) were categorized as eGFR 60–89 by CKD-EPI. After adjustment for covariates, eGFR <60 (CKD-EPI), eGFR <30 (MDRD) and eGFR ≥105 (both formulae) were significantly associated with an increased risk of death. Mortality in patients classified as having eGFR 60–89 by CKD-EPI and eGFR 30–59 by MDRD more closely resembled mortality of patients who had eGFR 60–89 by both formulae.
Conclusions. MDRD and CKD-EPI equations showed a high degree of agreement in stratifying patients by baseline eGFR. CKD-EPI estimates of GFR <60 at baseline are more strongly associated with mortality than MDRD estimates of GFR <60, supporting the concept that MDRD may have overestimated the severity of renal impairment in these patients. Our findings support the use of CKD-EPI in HIV-positive individuals.
Methods. We compared the CKD-EPI and MDRD equations to estimate GFR at baseline in 20 132 HIV-positive individuals in the UK CHIC cohort. Kappa statistics and Bland–Altman plots were used to assess agreement between the two estimates and Kaplan–Meier plots and Cox regression analysis to describe mortality patterns.
Results. At baseline, median eGFR was 100 (87, 112) (CKD-EPI) and 94 (83, 108) (MDRD) (mL/min/1.73m2). Good overall agreement between CKD-EPI- and MDRD-defined eGFR bands was observed (Kappa = 0.71, 95% confidence interval: 0.70–0.72). Of the 367 patients with eGFR MDRD 30–59, 57 (15.5%) were categorized as eGFR 60–89 by CKD-EPI. After adjustment for covariates, eGFR <60 (CKD-EPI), eGFR <30 (MDRD) and eGFR ≥105 (both formulae) were significantly associated with an increased risk of death. Mortality in patients classified as having eGFR 60–89 by CKD-EPI and eGFR 30–59 by MDRD more closely resembled mortality of patients who had eGFR 60–89 by both formulae.
Conclusions. MDRD and CKD-EPI equations showed a high degree of agreement in stratifying patients by baseline eGFR. CKD-EPI estimates of GFR <60 at baseline are more strongly associated with mortality than MDRD estimates of GFR <60, supporting the concept that MDRD may have overestimated the severity of renal impairment in these patients. Our findings support the use of CKD-EPI in HIV-positive individuals.
| Original language | English |
|---|---|
| Article number | N/A |
| Pages (from-to) | 2291-2297 |
| Number of pages | 7 |
| Journal | Nephrology, Dialysis, Transplantation |
| Volume | 27 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2012 |
Keywords
- Adolescent
- Adult
- Algorithms
- Cohort Studies
- Diet
- Female
- Follow-Up Studies
- Glomerular Filtration Rate
- HIV
- HIV Infections
- HIV Seropositivity
- Humans
- Kidney Failure, Chronic
- Male
- Middle Aged
- Prognosis
- Survival Rate
- Young Adult
