BACKGROUND: Although studies have reported a high prevalence of end-stage renal disease in human immunodeficiency virus (HIV)-infected individuals, little is known about moderate impairments in kidney function. Cystatin C measurement may be more sensitive than creatinine for detecting impaired kidney function in persons with HIV. METHODS: We evaluated kidney function in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) cohort, a representative sample of 1008 HIV-infected persons and 290 controls from the Coronary Artery Risk Development in Young Adults (CARDIA) study in the United States. RESULTS: Cystatin C level was elevated in HIV-infected individuals; the mean +/- SD cystatin C level was 0.92 +/- 0.22 mg/L in those infected with HIV and 0.76 +/- 0.15 mg/L in controls (P < .001). In contrast, both mean creatinine levels and estimated glomerular filtration rates appeared similar in HIV-infected individuals and controls (0.87 +/- 0.21 vs 0.85 +/- 0.19 mg/dL [to convert to micromoles per liter, multiply by 88.4] [P = .35] and 110 +/- 26 vs 106 +/- 23 mL/min/1.73 m(2) [P = .06], respectively). Persons with HIV infection were more likely to have a cystatin C level greater than 1.0 mg/L (OR, 9.8; 95% confidence interval, 4.4-22.0 [P <.001]), a threshold demonstrated to be associated with increased risk for death and cardiovascular and kidney disease. Among participants with HIV, potentially modifiable risk factors for kidney disease, hypertension, and low high-density lipoprotein concentration were associated with a higher cystatin C level, as were lower CD4 lymphocyte count and coinfection with hepatitis C virus (all P < .001). CONCLUSIONS: Individuals infected with HIV had substantially worse kidney function when measured by cystatin C level compared with HIV-negative controls, whereas mean creatinine levels and estimated glomerular filtration rates were similar. Cystatin C measurement could be a useful clinical tool to identify HIV-infected persons at increased risk for kidney and cardiovascular disease.
BACKGROUND: Although studies have reported a high prevalence of end-stage renal disease in human immunodeficiency virus (HIV)-infected individuals, little is known about moderate impairments in kidney function. Cystatin C measurement may be more sensitive than creatinine for detecting impaired kidney function in persons with HIV. METHODS: We evaluated kidney function in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) cohort, a representative sample of 1008 HIV-infectedpersons and 290 controls from the Coronary Artery Risk Development in Young Adults (CARDIA) study in the United States. RESULTS:Cystatin C level was elevated in HIV-infected individuals; the mean +/- SD cystatin C level was 0.92 +/- 0.22 mg/L in those infected with HIV and 0.76 +/- 0.15 mg/L in controls (P < .001). In contrast, both mean creatinine levels and estimated glomerular filtration rates appeared similar in HIV-infected individuals and controls (0.87 +/- 0.21 vs 0.85 +/- 0.19 mg/dL [to convert to micromoles per liter, multiply by 88.4] [P = .35] and 110 +/- 26 vs 106 +/- 23 mL/min/1.73 m(2) [P = .06], respectively). Persons with HIV infection were more likely to have a cystatin C level greater than 1.0 mg/L (OR, 9.8; 95% confidence interval, 4.4-22.0 [P <.001]), a threshold demonstrated to be associated with increased risk for death and cardiovascular and kidney disease. Among participants with HIV, potentially modifiable risk factors for kidney disease, hypertension, and low high-density lipoprotein concentration were associated with a higher cystatin C level, as were lower CD4 lymphocyte count and coinfection with hepatitis C virus (all P < .001). CONCLUSIONS: Individuals infected with HIV had substantially worse kidney function when measured by cystatin C level compared with HIV-negative controls, whereas mean creatinine levels and estimated glomerular filtration rates were similar. Cystatin C measurement could be a useful clinical tool to identify HIV-infectedpersons at increased risk for kidney and cardiovascular disease.
Authors: Samir K Gupta; Joseph A Eustace; Jonathan A Winston; Ivy I Boydstun; Tejinder S Ahuja; Rudolph A Rodriguez; Karen T Tashima; Michelle Roland; Nora Franceschini; Frank J Palella; Jeffrey L Lennox; Paul E Klotman; Sharon A Nachman; Stephen D Hall; Lynda A Szczech Journal: Clin Infect Dis Date: 2005-04-22 Impact factor: 9.079
Authors: U Pöge; T Gerhardt; B Stoffel-Wagner; H U Klehr; T Sauerbruch; R P Woitas Journal: Nephrol Dial Transplant Date: 2005-12-02 Impact factor: 5.992
Authors: Andrew S Levey; Kai-Uwe Eckardt; Yusuke Tsukamoto; Adeera Levin; Josef Coresh; Jerome Rossert; Dick De Zeeuw; Thomas H Hostetter; Norbert Lameire; Garabed Eknoyan Journal: Kidney Int Date: 2005-06 Impact factor: 10.612
Authors: Richard J Johnson; Mark S Segal; Titte Srinivas; Ahsan Ejaz; Wei Mu; Carlos Roncal; Laura G Sánchez-Lozada; Michael Gersch; Bernardo Rodriguez-Iturbe; Duk-Hee Kang; Jaime Herrera Acosta Journal: J Am Soc Nephrol Date: 2005-04-20 Impact factor: 10.121
Authors: Michael G Shlipak; Mark J Sarnak; Ronit Katz; Linda F Fried; Stephen L Seliger; Anne B Newman; David S Siscovick; Catherine Stehman-Breen Journal: N Engl J Med Date: 2005-05-19 Impact factor: 91.245
Authors: Janice Lea; Tom Greene; Lee Hebert; Michael Lipkowitz; Shaul Massry; John Middleton; Stephen G Rostand; Edgar Miller; Winifred Smith; George L Bakris Journal: Arch Intern Med Date: 2005-04-25
Authors: Michael G Shlipak; Christina L Wassel Fyr; Glenn M Chertow; Tamara B Harris; Stephen B Kritchevsky; Frances A Tylavsky; Suzanne Satterfield; Steven R Cummings; Anne B Newman; Linda F Fried Journal: J Am Soc Nephrol Date: 2005-11-02 Impact factor: 10.121
Authors: Phyllis C Tien; Constance Benson; Andrew R Zolopa; Stephen Sidney; Dennis Osmond; Carl Grunfeld Journal: Am J Epidemiol Date: 2006-03-08 Impact factor: 4.897
Authors: Christina Hao Wang; Anna D Rubinsky; Tracy Minichiello; Michael G Shlipak; Erika Leemann Price Journal: J Gen Intern Med Date: 2018-05-31 Impact factor: 5.128
Authors: Simon B Ascher; Rebecca Scherzer; Michelle M Estrella; Michael G Shlipak; Derek K Ng; Frank J Palella; Mallory D Witt; Ken Ho; Michael R Bennett; Chirag R Parikh; Joachim H Ix; Vasantha Jotwani Journal: Am J Nephrol Date: 2019-09-25 Impact factor: 3.754
Authors: Carl Grunfeld; Donald P Kotler; Donna K Arnett; Julian M Falutz; Steven M Haffner; Paul Hruz; Henry Masur; James B Meigs; Kathleen Mulligan; Peter Reiss; Katherine Samaras Journal: Circulation Date: 2008-06-19 Impact factor: 29.690
Authors: Chris T Longenecker; Douglas Kitch; Paul E Sax; Eric S Daar; Camlin Tierney; Samir K Gupta; Grace A McComsey Journal: J Acquir Immune Defic Syndr Date: 2015-06-01 Impact factor: 3.731
Authors: Amanda Mocroft; Christina Wyatt; Lynda Szczech; Jacquie Neuhaus; Wafaa El-Sadr; Russell Tracy; Lewis Kuller; Michael Shlipak; Brian Angus; Harting Klinker; Michael Ross Journal: AIDS Date: 2009-01-02 Impact factor: 4.177
Authors: Christopher I Esezobor; Edna Iroha; Olajumoke Oladipo; Elizabeth Onifade; Oyetunji O Soriyan; Adebola O Akinsulie; Edamisan O Temiye; Chinyere Ezeaka Journal: J Int AIDS Soc Date: 2010-05-18 Impact factor: 5.396