title: Comparison of CKD-EPI and MDRD to estimate baseline renal function in HIV-positive patients.
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/1.73 m(2)). 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.
authors: Department of Renal Sciences, King’s College London, London, UK.
authors: Fowzia
authors: F
authors: Ibrahim
authors: Lisa
authors: L
authors: Hamzah
authors: Rachael
authors: R
authors: Jones
authors: Dorothea
authors: D
authors: Nitsch
authors: Caroline
authors: C
authors: Sabin
authors: Frank A
authors: FA
authors: Post
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D015331:Cohort Studies; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006678:HIV / Q000302:isolation & purification / Q000472:pathogenicity*; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000821:virology; D006679:HIV Seropositivity; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult