Cystatin C in addition to creatinine for better assessment of glomerular renal function decline in people with HIV receiving antiretroviral therapy. (1st March 2023)

• Record Type: Journal Article
• Authors: Mondesert, Etienne; Reynes, Jacques; Makinson, Alain; Bargnoux, Anne-Sophie; Plawecki, Maëlle; Morquin, David; Cristol, Jean-Paul; Badiou, Stéphanie
• Is Part Of: AIDS. Volume 37:Number 3(2023)
• Page Start: 447
• Page End: 454
• Publication Date: 2023-03-01
• Subjects: antiretrovirals -- chronic kidney disease -- creatinine -- cystatin C -- glomerular filtration rate -- HIV-1; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000003434
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: To compare the estimated glomerular filtration rate (eGFR) using the creatinine equation (eGFRcreat) or the cystatin C equation (eGFRcys) in people with HIV (PWH) under antiretroviral drugs. We specifically included patients with an eGFRcreat around 60 ml/min per 1.73 m 2 to evaluate agreement on stage 2 and 3 chronic kidney disease (CKD) classification. Design: eGFRcreat, eGFRcys and resulting CKD staging were determined in 262 consecutive patients with HIV-1 (PWH) with a suppressed viral load (<200 copies/ml) under antiretroviral drugs and having impaired renal function (eGFRcreat between 45 and 80 ml/min per 1.73 m 2 ). Antiretroviral drugs regimens were classified into eight groups: cobicistat (COBI)+elvitegravir (EVG), ritonavir (RTV)+protease inhibitor, dolutegravir (DTG), DTG+rilpivirine (RPV), RPV, raltegravir (RAL), bictegravir (BIC), and other antiretroviral drugs. Results: Mean eGFRcys was higher than mean eGFRcreat (77.7 ± 0.5 vs. 67.9 ± 7.9 ml/min per 1.73 m 2, P < 0.0001). The differences were significant in five treatment groups with COBI/EVG; DTG; DTG+RPV; RPV; RAL. CKD classification was modified for 51% of patients when using eGFRcys instead of eGFRcreat, with reclassification to less severe stages in 37% and worse stages in 14%. Conclusion: This study highlighted significant differences in eGFR depending on the renal marker used in PWH, having a significant impact on CKD classification. eGFRcys should be an additive tool for patients having eGFRcreat around 60 ml/min per 1.73 m 2 for better identification of renal impairment.