Abstract
BackgroundThe measurement of serum creatinine is a standard requirement of the medical management of people living with HIV. Renal dysfunction is common, both as a complication of HIV-infection and as a result of its treatment. The detection of abnormal renal function before the start of antiretroviral therapy will impact patient management and the outcome of treatment.ObjectivesThis study aimed to determine if a time delay in the centrifugation of serum samples affected the creatinine level and the estimated glomerular filtration rate as recorded on the analytical platforms used in the laboratory.MethodsTwenty-two (n = 22) HIV-positive, newly diagnosed and treatment-naïve patients were randomly recruited from Alexandra Health Clinic, Johannesburg, South Africa. Serum samples were centrifuged at six time intervals following receipt of the sample viz. < 4 h (baseline), 6 h, 24 h, 48 h, 72 h and 96 h. Creatinine concentrations were measured on the Roche platform utilising the enzymatic and kinetic Jaffe methods. Whole blood samples were also analysed with the Abbott i-STAT point-of-care instrument. The estimated glomerular filtration rate was calculated using the Cockcroft Gault, CKD–Epidemiology Collaboration and Modified Diet and Renal Disease v3/4 equations.ResultsAt baseline (< 4 h) there was good agreement between the enzymatic and kinetic Jaffe methods: bias 1.7 µmol/l. The enzymatic and i-STAT creatinine concentrations were stable over 96 h viz. changes of 1.8% and 5.7%. However, from 24 h onwards agreement between the enzymatic and kinetic Jaffe methods was poor with the latter measuring 43.7 µmol/l higher than the enzymatic method at 96 h. Creatinine concentrations measured with the kinetic Jaffe method increased significantly in samples centrifuged after 6 h (p < 0.001, 61.7% change), and resulted in a 95% decline in eGFR at 96 h as determined with the CKD–Epidemiology Collaboration equation.ConclusionThe analysis of serum creatinine using the isotope dilution mass spectrometry traceable kinetic Jaffe method is unreliable if performed on samples centrifuged ≥ 6 h after collection. The raised creatinine concentration can affect clinical decisions such as renal functional assessment, choice of antiretroviral drug or regimen, and the dose and frequency of medication.
Highlights
South Africa (SA) has one of the highest HIV infection rates in the world
Creatinine concentrations measured with the kinetic Jaffe method increased significantly in samples centrifuged after 6 h (p < 0.001, 61.7% change), and resulted in a 95% decline in estimated glomerular filtration rate (eGFR) at 96 h as determined with the Chronic Kidney Disease (CKD)–Epidemiology Collaboration equation
The analysis of serum creatinine using the isotope dilution mass spectrometry traceable kinetic Jaffe method is unreliable if performed on samples centrifuged ≥ 6 h after collection
Summary
South Africa (SA) has one of the highest HIV infection rates in the world. In 2016, the overall prevalence of HIV infection in SA was 12.7%.1,2 The use of antiretroviral drugs (ARVs) has slowed the progression of the infection and increased the life expectancy of people living with HIV.[3,4,5] In SA’s public health sector, patients are started on antiretroviral treatment (ART) with combinations of different ARV drug classes, prescribed as a single, once-a-day tablet.[6]. In 2016, the overall prevalence of HIV infection in SA was 12.7%.1,2. The use of antiretroviral drugs (ARVs) has slowed the progression of the infection and increased the life expectancy of people living with HIV.[3,4,5] In SA’s public health sector, patients are started on antiretroviral treatment (ART) with combinations of different ARV drug classes, prescribed as a single, once-a-day tablet.[6] This has led to a reduction of the pill-burden of therapy and to improved adherence.[7,8] In the southern African region the most frequently prescribed initial combination is the nucleotide reverse transcriptase http://www.sajhivmed.org.za. Both as a complication of HIV-infection and as a result of its treatment. The detection of abnormal renal function before the start of antiretroviral therapy will impact patient management and the outcome of treatment
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