Cystatin C and Baseline Renal Function Among HIV-Infected Persons in the SUN Study

Abstract

In the combination antiretroviral therapy (cART) era, renal dysfunction remains common. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) (ClinicalTrials.gov number, NCT00146419) is a prospective observational cohort study of HIV-infected adults. At baseline, comprehensive data were collected, including cystatin C and measures of renal function. Univariate and multivariate regression analyses were performed to identify factors associated with baseline renal dysfunction [estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m 2 calculated using the simplified Modification of Diet in Renal Disease equation] and elevated cystatin C ( > 1.0 mg/liter) in a cross-sectional analysis. Among 670 subjects with complete data (mean age 41 years, mean CD4 cell count 530 cells/mm 3 , 79% prescribed cART), the mean eGFR was 96.8 ml/min/1.73 m 2 . Forty percent of subjects had renal dysfunction; 3.3% had chronic kidney disease (eGFR < 60 ml/min/1.73 m 2 ). Elevated cystatin C was present in 18% of subjects. In multivariate analysis, renal dysfunction was associated with older age, non-Hispanic white race/ethnicity, higher body mass index (BMI), hypertension, higher cystatin C levels, and current prescription of ritonavir. Factors associated with elevated cystatin C included hepatitis C coinfection, hypertension, current smoking, older age, current tenofovir use, detectable plasma HIV RNA, and elevated microalbuminuria. The prevalence of chronic kidney disease (CKD) was low in this contemporary HIV cohort. However, mild to moderate renal dysfunction was common despite the widespread use of cART.

Tenofovir Use and Urinary Biomarkers Among HIV-Infected Women in the Women's Interagency HIV Study (WIHS)

“…Similarly, uncontrolled HIV viremia has been linked to renal dysfunction in a large randomized trial [22]. Our findings of the association between uncontrolled HIV viremia with urinary biomarker elevation supports the findings from a recent cohort study which noted an association between detectable HIV RNA (> 400 copies/ml) and elevated cystatin C, another biomarker of renal function [23]. This suggests that the development of these biomarkers as clinical guides will need to take into account the medical history of the patient as well as the effectiveness of their HIV directed care.…”

The Disagreement Among Methods to Evaluate Glomerular Filtration Rate in HIV-Infected Patients Naive to Antiretroviral Therapy

“…13 Also in this study a significant direct correlation between MDRD and CKD-EPI was found using Spearman correlation (r s = 0.94, p < 0.001). In another paper, 14 Dabrowska et al used paired t-test to demonstrate that GFR estimated by CKD-EPI was consistently lower than MDRD.…”

Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS

“…Twenty-six publications reported HBV infection prevalence [63, 65, 69, 71, 79-81, 89, 102, 106, 110, 123, 141, 144, 147, 150, 151, 154, 157, 159, 162, 165, 170, 172, 174, 175]. HBV infection was defined in 72% of individual studies as positive by HBV surface antigen test (see Supplemental Table S7 for all definitions).…”