title: Chronic kidney disease and estimates of kidney function in HIV infection: a cross-sectional study in the multicenter AIDS cohort study.
abstract: BACKGROUND
  Cystatin C has been proposed as an alternative marker of kidney function among HIV-infected persons in whom serum creatinine is affected by extrarenal factors.
  
  
  METHODS
  In this cross-sectional study, we compared estimated glomerular filtration rates (eGFR) using serum creatinine versus cystatin C between 150 HIV-uninfected and 783 HIV-infected men. We evaluated the prevalence of chronic kidney disease (CKD; eGFR less than 60 mL/min/1.73 m) and examined the influence of extrarenal factors on GFR estimates among HIV-infected men.
  
  
  RESULTS
  Estimated GFRSCR was similar by HIV serostatus, but eGFRCYSC was lower in HIV-infected men. A higher proportion of HIV-infected men were classified as having CKD when using eGFRCYSC versus eGFRSCR (7% vs 5%, P < 0.01). In HIV-infected individuals without CKD, eGFRSCR was higher than eGFRCYSC, whereas it was lower than eGFRCYSC in persons with CKD. In HIV-infected men, older age, proteinuria, and prior clinical AIDS were inversely associated with both GFR estimates. Higher serum albumin levels and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use were associated with lower eGFRSCR. HIV viral load, hepatitis C coinfection, and serum alkaline phosphatase were inversely associated with eGFRCYSC.
  
  
  CONCLUSIONS
  Among HIV-uninfected and HIV-infected men of similar social risk behaviors, GFR estimates differed by biomarker and kidney function level. Estimated GFRCYSC classified a larger proportion of HIV-infected men with CKD compared with eGFRSCR. Differences between these GFR-estimating methods may be the result of the effects of extrarenal factors on serum creatinine and cystatin C. Until GFR-estimating equations are validated among HIV-infected individuals, current GFR estimates based on these biomarkers should be interpreted with care in this patient population.
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Robert
authors.initials: R
authors.lastname: Bolan
authors.forename: Rhobert W
authors.initials: RW
authors.lastname: Evans
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000375:Aging; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011507:Proteinuria; D044469:Racial Groups; D012307:Risk Factors
chemical_list: D055316:Cystatin C; D003404:Creatinine