Abstract
ObjectivesThe aim of this study was to determine whether the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)- or Cockcroft−Gault (CG)-based estimated glomerular filtration rates (eGFRs) performs better in the cohort setting for predicting moderate/advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD).MethodsA total of 9521 persons in the EuroSIDA study contributed 133 873 eGFRs. Poisson regression was used to model the incidence of moderate and advanced CKD (confirmed eGFR < 60 and < 30 mL/min/1.73 m2, respectively) or ESRD (fatal/nonfatal) using CG and CKD-EPI eGFRs.ResultsOf 133 873 eGFR values, the ratio of CG to CKD-EPI was ≥ 1.1 in 22 092 (16.5%) and the difference between them (CG minus CKD-EPI) was ≥ 10 mL/min/1.73 m2 in 20 867 (15.6%). Differences between CKD-EPI and CG were much greater when CG was not standardized for body surface area (BSA). A total of 403 persons developed moderate CKD using CG [incidence 8.9/1000 person-years of follow-up (PYFU); 95% confidence interval (CI) 8.0–9.8] and 364 using CKD-EPI (incidence 7.3/1000 PYFU; 95% CI 6.5–8.0). CG-derived eGFRs were equal to CKD-EPI-derived eGFRs at predicting ESRD (n = 36) and death (n = 565), as measured by the Akaike information criterion. CG-based moderate and advanced CKDs were associated with ESRD [adjusted incidence rate ratio (aIRR) 7.17; 95% CI 2.65–19.36 and aIRR 23.46; 95% CI 8.54–64.48, respectively], as were CKD-EPI-based moderate and advanced CKDs (aIRR 12.41; 95% CI 4.74–32.51 and aIRR 12.44; 95% CI 4.83–32.03, respectively).ConclusionsDifferences between eGFRs using CG adjusted for BSA or CKD-EPI were modest. In the absence of a gold standard, the two formulae predicted clinical outcomes with equal precision and can be used to estimate GFR in HIV-positive persons.
Highlights
With increasing survival rates in HIV-positive persons, there is an increase in the number of studies focusing on non-AIDSrelated conditions, including renal disease and markers of renal function, such as glomerular filtration rate (GFR)
A third formula, Cockcroft−Gault (CG), estimates creatinine clearance [3]. These are based on serum creatinine measurements, which are subject to considerable intrapersonal variation [4], which increases at higher levels of serum creatinine [5]
The CG and Modification of Diet in Renal Disease (MDRD) equations have been widely used in HIV-positive persons, even though they were derived in HIV-negative persons with other chronic illnesses, while the chronic kidney disease (CKD)-EPI formula was derived in a less selected population [6]
Summary
With increasing survival rates in HIV-positive persons, there is an increase in the number of studies focusing on non-AIDSrelated conditions, including renal disease and markers of renal function, such as glomerular filtration rate (GFR). Two formulae are commonly used to estimate GFR; the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. A third formula, Cockcroft−Gault (CG), estimates creatinine clearance [3]. These are based on serum creatinine measurements, which are subject to considerable intrapersonal variation [4], which increases at higher levels of serum creatinine [5]. The CG and MDRD equations have been widely used in HIV-positive persons, even though they were derived in HIV-negative persons with other chronic illnesses, while the CKD-EPI formula was derived in a less selected population [6]. Similar formula preferences exist for HIV-positive persons, as MDRD and CKD-EPI do not require information on body weight, while the CG formula does not require race
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