Journal
NEPHROLOGY DIALYSIS TRANSPLANTATION
Volume 27, Issue 6, Pages 2291-2297Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfr657
Keywords
chronic kidney disease; CKD-EPI; eGFR; HIV; MDRD
Categories
Funding
- Medical Research Council, UK [G00001999, G0600337]
- National Institute for Health Research, UK
- Medical Research Council [G0600337] Funding Source: researchfish
- National Institute for Health Research [DRF-2009-02-54] Funding Source: researchfish
- MRC [G0600337] Funding Source: UKRI
- National Institutes of Health Research (NIHR) [DRF-2009-02-54] Funding Source: National Institutes of Health Research (NIHR)
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Background. Renal dysfunction is common in HIV-positive patients, and guidelines suggest regular monitoring of renal function with estimated glomerular filtration rate (eGFR) and urinalysis. It is unknown whether Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) or Modification of Diet in Renal Disease (MDRD) provide better estimates of glomerular filtration rate (GFR) in this population. Methods. We compared the CKD-EPI and MDRD equations to estimate GFR at baseline in 20 132 HIV-positive individuals in the UK CHIC cohort. Kappa statistics and Bland-Altman plots were used to assess agreement between the two estimates and Kaplan-Meier plots and Cox regression analysis to describe mortality patterns. Results. At baseline, median eGFR was 100 (87, 112) (CKD-EPI) and 94 (83, 108) (MDRD) (mL/min/1.73m(2)). Good overall agreement between CKD-EPI- and MDRD-defined eGFR bands was observed (Kappa = 0.71, 95% confidence interval: 0.70-0.72). Of the 367 patients with eGFR MDRD 30-59, 57 (15.5%) were categorized as eGFR 60-89 by CKD-EPI. After adjustment for covariates, eGFR <60 (CKD-EPI), eGFR <30 (MDRD) and eGFR >= 105 (both formulae) were significantly associated with an increased risk of death. Mortality in patients classified as having eGFR 60-89 by CKD-EPI and eGFR 3059 by MDRD more closely resembled mortality of patients who had eGFR 60-89 by both formulae. Conclusions. MDRD and CKD-EPI equations showed a high degree of agreement in stratifying patients by baseline eGFR. CKD-EPI estimates of GFR <60 at baseline are more strongly associated with mortality than MDRD estimates of GFR <60, supporting the concept that MDRD may have overestimated the severity of renal impairment in these patients. Our findings support the use of CKD-EPI in HIV-positive individuals.
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