Estimation of renal function by CKD-EPI versus MDRD in a cohort of HIV-infected patients: a cross-sectional analysis.
BACKGROUND
Accurately determining renal function is essential for clinical management of HIV patients. Classically, it has been evaluated by estimating glomerular filtration rate (eGFR) with the MDRD-equation, but today there is evidence that the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has greater diagnostic accuracy. To date, however, little information exists on patients with HIV-infection. This study aimed to evaluate eGFR by CKD-EPI vs. MDRD equations and to stratify renal function according to KDIGO guidelines.


METHODS
Cross-sectional, single center study including adult patients with HIV-infection.


RESULTS
Four thousand five hundred three patients with HIV-infection (864 women; 19%) were examined. Median age was 45 years (IQR 37-52), and median baseline creatinine was 0.93 mg/dL (IQR 0.82-1.05). A similar distribution of absolute measures of eGFR was found using both formulas (p = 0.548). Baseline median eGFR was 95.2 and 90.4 mL/min/1.73 m2for CKD-EPI and MDRD equations (p < 0.001), respectively. Of the 4503 measurements, 4109 (91.2%) agreed, with a kappa index of 0.803. MDRD classified 7.3% of patients as "mild reduced GFR" who were classified as "normal function" with CKD-EPI. Using CKD-EPI, it was possible to identify "normal function" (>90 mL/min/1.73 m2) in 73% patients and "mild reduced GFR" (60-89 mL/min/1.73 m2) in 24.3% of the patients, formerly classified as >60 mL/min/1.73 m2with MDRD.


CONCLUSIONS
There was good correlation between CKD-EPI and MDRD. Estimating renal function using CKD-EPI equation allowed better staging of renal function and should be considered the method of choice. CKD-EPI identified a significant proportion of patients (24%) with mild reduced GFR (60-89 mL/min/1.73 m2).
Kidney Transplant Division, Hospital do Rim (São Paulo, Brazil), Universidade Federal de São Paulo, São Paulo, Brazil.
M P
MP
Cristelli
Nephrology and Renal Transplantation Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
F
F
Cofán
Core Laboratory, Biomedical Diagnosis Centre, Hospital Clínic, Barcelona, Spain.
N
N
Rico
Internal Medicine Service, Hospital de Olot, Girona, Spain.|Medical Sciences Department, University of Girona, Girona, Spain.
J C
JC
Trullàs
Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
C
C
Manzardo
Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
F
F
Agüero
Core Laboratory, Biomedical Diagnosis Centre, Hospital Clínic, Barcelona, Spain.
J L
JL
Bedini
Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
A
A
Moreno
Nephrology and Renal Transplantation Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
F
F
Oppenheimer
Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain. jmmiro@ub.edu.
J M
JM
Miro
D000328:Adult; D000368:Aged; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000209:etiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
Chronic kidney disease; Glomerular filtration rate estimates; HIV-infection