title: Cystatin C and baseline renal function among HIV-infected persons in the SUN Study.
abstract: In the combination antiretroviral therapy (cART) era, renal dysfunction remains common. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) (ClinicalTrials.gov number, NCT00146419) is a prospective observational cohort study of HIV-infected adults. At baseline, comprehensive data were collected, including cystatin C and measures of renal function. Univariate and multivariate regression analyses were performed to identify factors associated with baseline renal dysfunction [estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m(2) calculated using the simplified Modification of Diet in Renal Disease equation] and elevated cystatin C (>1.0 mg/liter) in a cross-sectional analysis. Among 670 subjects with complete data (mean age 41 years, mean CD4 cell count 530 cells/mm(3), 79% prescribed cART), the mean eGFR was 96.8 ml/min/1.73 m(2). Forty percent of subjects had renal dysfunction; 3.3% had chronic kidney disease (eGFR < 60 ml/min/1.73 m(2)). Elevated cystatin C was present in 18% of subjects. In multivariate analysis, renal dysfunction was associated with older age, non-Hispanic white race/ethnicity, higher body mass index (BMI), hypertension, higher cystatin C levels, and current prescription of ritonavir. Factors associated with elevated cystatin C included hepatitis C coinfection, hypertension, current smoking, older age, current tenofovir use, detectable plasma HIV RNA, and elevated microalbuminuria. The prevalence of chronic kidney disease (CKD) was low in this contemporary HIV cohort. However, mild to moderate renal dysfunction was common despite the widespread use of cART.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri 63110, USA. toverton@dom.wustl.edu
authors.forename: Edgar Turner
authors.initials: ET
authors.lastname: Overton
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.forename: Kristin
authors.initials: K
authors.lastname: Mondy
authors.forename: Tim
authors.initials: T
authors.lastname: Bush
authors.forename: Lois
authors.initials: L
authors.lastname: Conley
authors.forename: Frank
authors.initials: F
authors.lastname: Rhame
authors.forename: Erna Milunka
authors.initials: EM
authors.lastname: Kojic
authors.forename: John
authors.initials: J
authors.lastname: Hammer
authors.forename: Keith
authors.initials: K
authors.lastname: Henry
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D005919:Glomerular Filtration Rate; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D006526:Hepatitis C / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D055316:Cystatin C; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine; D019438:Ritonavir