Brief Report: Cystatin C-Based Estimation of Glomerular Filtration Rate and Association With Atherosclerosis Imaging Markers in People Living With HIV
Year: 2020
Type: article
Abstract: INTRODUCTION: Reduced estimated glomerular filtration rate (eGFR) is associated with increased risk of cardiovascular disease among people living with HIV (PLWH). It is unclear whether eGFR equations incorporating cystatin C (CysC) measurements are more predictive of preclinical cardiovascular disease than those using only creatinine (Cr). OBJECTIVES: The study aimed to determine which of the 3 Chronic Kidney Disease Epidemiology (CKD-EPI) eGFR equations is most associated with carotid intima media thickness (CIMT) and coronary artery calcium (CAC) score. METHODS: This cross-sectional analysis of pooled data from 3 large cohorts compared the associations between the 3 CKD-EPI eGFR equations (Cr, CysC, and Cr-CysC) with CIMT and CAC score using multivariable regression analysis. eGFR and CIMT were analyzed as continuous variables. CAC scores were analyzed as a binary variable (detectable calcification versus nondetectable) and as a log10 Agatston score in those with detectable CAC. RESULTS: Thousand four hundred eighty-seven participants were included, and of these 910 (562 HIV+ and 348 HIV-) had CIMT measurements and 366 (296 HIV+ and 70 HIV-) had CAC measurements available. In HIV- participants, GFR estimated by any CKD-EPI equation did not significantly correlate with CIMT or CAC scores. When PLWH were analyzed separately including HIV-specific factors, only GFR estimated using Cr-Cys C correlated with CIMT [β= -0.90, 95% CI: (-1.67 to -0.13) μm; P = 0.023]. Similarly, eGFR correlated with Agatston scores only when using cystatin C-based eGFR [β= -8.63, 95% CI: (-16.49 to -0.77) HU; P = 0.034]. Associations between other eGFR formulas and CAC did not reach statistical significance. CONCLUSIONS: In PLWH, preclinical atherosclerosis may be more closely correlated with eGFR using formulae that incorporate CysC measurements than Cr alone.
Institutions: Indiana University Indianapolis, Indiana University School of Medicine, University of Washington, University of California, Los Angeles, The Lundquist Institute, University of California, San Francisco, San Francisco VA Health Care System, Vanderbilt University, VA Tennessee Valley Healthcare System, Vanderbilt University Medical Center, University of Southern California, Northwestern University, University of Hawaiʻi at Mānoa, Johns Hopkins University, Johns Hopkins Medicine
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Center/Coordination, Analysis and Management/MACS, CVD and Metabolic Complications of HIV/AIDS Data Coordinating Center, UCLA Clinical and Translational Science Institute, Natural History of AIDS in Homosexual Men, University of Pittsburgh Multicenter AIDS Cohort Study (MACS), Institute for Clinical and Translational Research, Multicenter AIDS Cohort Study, Subclinical Vascular Disease and Metabolic Abnormalities in MACS, Multicenter AIDS Cohort Study - Part B (Baltimore Center), Los Angeles CRS for the MACS/WIHS Combined Cohort Study, UCLA Clinical and Translational Science Institute
OpenAlex ID: W3046577576