Comparative Analysis of the New Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease Equations for Estimation of Glomerular Filtration Rate in HIV Type 1-Infected Subjects

Abstract

Recently, a new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was presented as a better alternative to the modification of diet in renal disease (MDRD) formula for GFR estimation (eGFR) in patients with relatively well-preserved kidney function. The main objective of our study was to compare the eGFR results arrived by the new CKD-EPI to the older MDRD equation in antiretroviral (ARV)-naive and ARV-treated HIV-1-infected patients. The study was performed in 287 adult HIV-1-infected patients and was an evaluation comparing eGFR results based on age, gender, race, and serum creatinine. The biggest difference in estimated glomerular filtration rate (eGFR) measured by the two formulas was seen in ARV-naive men with well-preserved kidney function (p = 0.001). Moreover, we found a significant negative correlation between mean difference in eGFR measured by the two equations and the age of the studied subjects (r = -0.37, p < 0.001). No correlation was observed between mean difference in eGFR and HIV viral load (r = -0.15, p = 0.2). Independent of the equation used, a significant decrease of eGFR in ARV-treated in comparison to ARV-untreated HIV-1-infected patients was seen (p < 0.001). In conclusion, in HIV-1-infected subjects, especially in ARV-naive men with well-preserved kidney function, eGFR measured by MDRD and CKD-EPI formulas varies strongly following the method used. Such discrepancies may be important in everyday clinical practice and must be confirmed by additional studies using GFR measured with a reference method.

Increased Time Exposure to Tenofovir Is Associated with a Greater Decrease in Estimated Glomerular Filtration Rate in HIV Patients with Kidney Function of Less than 60 ml/min/1.73 m²

“…Furthermore, the GFR was estimated with S Cr measurements calibrated to isotope dilution mass spectrometry, allowing a proper use of the equation. Recent studies on eGFR performance in HIV patients showed that CKD-EPI and MDRD were similar for an eGFR below 60 ml/min/1.73 m 2 [46] and that sensitivity analysis using CKD-EPI provided similar results. Moreover, other studies have shown that the use of creatinine-based equations for CKD diagnosis can lead to missclassification, with the risk of overdiagnosis of CKD [47,48,49].…”

Does first-line antiretroviral regimen impact risk for chronic kidney disease whatever the risk group?

“…Very few studies indeed documented the optimal GFR estimation equation in people living with HIV by comparison to the gold standard measurements. Most studies compared different equations without using a gold standard measurement which really does not add any information with regard to the validity of the result contrary to what the authors usually state [16,17]. The largest study was conducted by Inker et al [18].…”

A comparison of estimated glomerular filtration rates using Cockcroft−Gault and the Chronic Kidney Disease Epidemiology Collaboration estimating equations in HIV infection

“…Studies of the general population and HIV-positive persons have typically compared the MDRD and CKD-EPI equations, and found the CKD-EPI equation to be closer to the gold standard [7][8][9][10][15][16][17]29]. In the absence of a gold standard in this and the majority of epidemiological studies in HIV-infected populations, the predictive ability of the two formulae for key clinical outcomes, such as ESRD or mortality, should be an important consideration.…”