Comparisons between validated estimated glomerular filtration rate equations and isotopic glomerular filtration rate in HIV patients.
OBJECTIVE
Understanding how best to measure renal function in HIV-infected patients is critical because estimated glomerular filtration rate (eGFR) in HIV-infected patients can be affected by ethnicity and body composition. We validated the available eGFR equations and compared them to the plasma Tc-diethylenetriaminepentaacetic acid (Tc-DTPA) clearance in HIV-infected patients.


METHODS
Test of diagnostic accuracy.


METHODS
One hundred and ninety-six HIV-infected patients underwent measuring of Tc-DTPA plasma clearance, five creatinine-based eGFR equations, cystatin-C GFR, and 24-h urine creatinine clearance (CrCl).


RESULTS
Mean (SD) Tc-DTPA GFR was 117.7 ± 29.2 ml/min per 1.73 m. The re-expressed Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), re-expressed MDRD formula with Thai racial correction factor, Thai eGFR equation, Cockcroft-Gault equation, cystatin-C GFR, and 24-h urine CrCl underestimated the reference GFR. The bias estimated by the mean of differences (SD) for the re-expressed MDRD equation, CKD-EPI, re-expressed MDRD formula with Thai racial correction factor, Thai eGFR, Cockcroft-Gault equation, cystatin-C, and 24-h urine CrCl can be expressed as 18.9 ± 27.3, 11.1 ± 25.5, 6.2 ± 28.8, 15.4 ± 27.0, 30.4 ± 28.0, 3.2 + 36.1, and 5.0 ± 12.1 ml/min per 1.73 m, respectively.


CONCLUSIONS
The available eGFR equations underestimated GFR in HIV-infected adults. However, the eGFR by cystatin-C GFR was the most precise and accurate. Among creatinine-based eGFR equations, re-expressed MDRD formula with Thai racial correction factor was the most precise and accurate. The racial factor for each ethnicity is important and the existing eGFR equation should be validated before using it in the HIV population.
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University. Bangkok, Thailand. kearkiat.p@md.chula.ac.th
Kearkiat
K
Praditpornsilpa
Anchalee
A
Avihingsanon
Tawatchai
T
Chaiwatanarat
Prachya
P
Chaiyahong
Jiratchaya
J
Wongsabut
Sasiwimol
S
Ubolyam
Adhisabandh
A
Chulakadabba
Yingyos
Y
Avihingsanon
Kiat
K
Ruxrungtham
Kriang
K
Tunsanga
Somchai
S
Eiam-Ong
Praphan
P
Phanuphak
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000208:ethnology / Q000503:physiopathology*; D000328:Adult; D000465:Algorithms; D019380:Anti-HIV Agents; D044466:Asian People; D001823:Body Composition; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000208:ethnology / Q000503:physiopathology*; D008297:Male; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D016284:Technetium Tc 99m Pentetate; D013785:Thailand; D019562:Viral Load
D019380:Anti-HIV Agents; D055316:Cystatin C; D019275:Radiopharmaceuticals; D003404:Creatinine; D016284:Technetium Tc 99m Pentetate