title: Comparison of cystatin C and creatinine to determine the incidence of composite adverse outcomes in HIV-infected individuals.
abstract: BACKGROUND
  Cystatin C is an overall biomarker of pathophysiologic abnormalities that accompany chronic kidney disease (CKD). The utility of cystatin C is not fully understood in an HIV-infected population.
  
  
  METHODS
  This prospective study investigated 661 HIV-infected individuals for 4 years to determine the incidence of adverse outcomes, including all-cause mortality, cardiovascular disease, and renal dysfunction. The risk of developing the outcomes was discriminated with a 4 color-coded classification in a 3 × 6 contingency table, that combined 3 grades of dipstick proteinuria with 6 grades of estimated glomerular filtration rate (eGFR) calculated using either serum creatinine (eGFRcr) or cystatin C (eGFRcy): green, low risk; yellow, moderately increased risk; orange, high risk; and red, very high risk. The cumulative incidence of the outcomes was assessed by the Kaplan-Meier method, and the association between color-coded risk and the time to outcome was evaluated using multivariate proportional hazards analysis.
  
  
  RESULTS
  Compared with eGFRcr, the use of eGFRcy reduced the prevalence of risk ≥ orange by 0.8%. The adverse outcomes were significantly more likely to occur to the patients with baseline risk category ≥orange than those with ≤ yellow, independent of risk categories based on eGFRcr or eGFRcy. However, in multivariate analysis, risk category ≥orange with eGFRcy-based classification was significantly associated with adverse outcomes, but not the one with eGFRcr.
  
  
  CONCLUSIONS
  Replacing creatinine by cystatin C in the CKD color-coded risk classification may be appropriate to discriminate HIV-infected patients at increased risk of a poor prognosis.
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yanagisawa
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
authors.forename: Shugo
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suganuma
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Imamura
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan; Toshima Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ajisawa
authors.affiliation: Department of Nephrology, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo 113-0021, Japan. Electronic address: hdcn@cick.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ando
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000821:virology; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology / Q000821:virology*
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: Cardiovascular disease; Cystatin C; Estimated glomerular filtration; HIV; Mortality; Proteinuria