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Improved Correlation of Coronary Atherosclerosis with Estimated Glomerular Filtration Rate Assessed with Chronic Kidney Disease Epidemiology Collaboration Equation than with MDRD and Cockcroft-Gault in HIV-infected Patients
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Reported by Jules Levin
CROI 2010 Feb 16-19 SF
Giovanni Guaraldi*1, S Zona1, V Albertazzi1, C Giovanardi1, G Orlando1, F Carli1, B Beghetto1, G Nardni1, G Cappelli1, and P Raggi2
1Univ of Modena and Reggio Emilia, Italy and 2Emory Univ Sch of Med, Atlanta, GA, US
"The level of agreement between CKD-EPI and both MDRD and CG is far from ideal. A greater accuracy of the CKD-EPI equation was found in defining CKD stages and the association with coronary atherosclerosis. CKD-EPI in HIV setting has the potential to improve clinical decision making in patients with decreased kidney function. Falsely low estimated GFR assessed with MDRD or CG formulas could lead to incorrect drug dosing, withholding of important diagnostic tests, and specific antiretroviral drugs."
ABSTRACT
Background: The Modification of Diet in Renal Disease Study equation (MDRD) and the Cockcroft-Gault formula (CG) are commonly used to estimate glomerular filtration rate (eGFR), but they are imprecise and underestimate GFR at higher values. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation was recently validated in a US population sample and appears more accurate than MDRD. Chronic kidney disease (CKD) increases cardiovascular risk. Coronary artery calcification (CAC), a non invasive marker of atherosclerosis, increases with the progression of CKD independent of age and sex, and is a strong predictor of mortality in CKD. We aimed to assess the concordance between creatinine equations used to estimate GFR and their association with coronary atherosclerosis determined with CAC imaging in HIV patients.
Methods: This was an observational, cross-sectional study. Estimated GFR was calculated with MDRD, CG, and CKD-EPI formulas in a cohort of HIV-infected patients receiving ART, with no previous cardiovascular disease attending a cardiometabolic clinic.
In a subset of 698 patients CAC imaging was measured on multidetector CT; CAC score>100 was used to define high risk of coronary artery disease. K statistic was used to describe concordance between MDRD, CG, and CKD-EPI equations. Spearman's Rho correlation analysis was used to determine association between MDRD, CG, and CKD-EPI eGFR values and prevalence of CAC>100.
Results: In a cohort of 1523 patients, prevalence of CKD (GFR<60 mL/min) was 3.7%, 3.4%, and 0.4% according to MDRD, CG, and CKD-EPI, respectively.
Figure 1 shows CKD stages according to the 3 creatinine equations.
All the CKD stage 3 patients were diagnosed stage <3 with MDRD or CG formulas.
Spearman's Rho correlation coefficient between GFR and CAC>100 was: r = -0.02, P =0.66 for MDRD, r = -0.06, P =0.09 for CG, and r = -0.16, P <0.01 for CKD-EPI.
Conclusions: The level of agreement between CKD-EPI and both MDRD and CG is far from ideal. A greater accuracy of the CKD-EPI equation was found in defining CKD stages and the association with coronary atherosclerosis. CKD-EPI in HIV setting has the potential to improve clinical decision making in patients with decreased kidney function. Falsely low estimated GFR assessed with MDRD or CG formulas could lead to incorrect drug dosing, withholding of important diagnostic tests, and specific antiretroviral drugs.
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