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Cystatin C-Based Estimation of Glomerular Filtration Rate and Association With Atherosclerosis Imaging Markers in People Living With HIV
JAIDS: Journal of Acquired Immune Deficiency Syndromes ( IF 2.9 ) Pub Date : 2020-12-01 , DOI: 10.1097/qai.0000000000002467
Mitchell McClean 1 , Petra Buzkova 2 , Matthew Budoff 3 , Michelle Estrella 4 , Matthew Freiberg 5 , Howard N. Hodis 6 , Frank Palella 7 , Cecilia Shikuma 8 , Wendy S. Post 9 , Samir Gupta 1
Affiliation  

Introduction: 

Reduced estimated glomerular filtration rate (eGFR) is associated with increased risk of cardiovascular disease among people living with HIV (PLWH). It is unclear whether eGFR equations incorporating cystatin C (CysC) measurements are more predictive of preclinical cardiovascular disease than those using only creatinine (Cr).

Objectives: 

The study aimed to determine which of the 3 Chronic Kidney Disease Epidemiology (CKD-EPI) eGFR equations is most associated with carotid intima media thickness (CIMT) and coronary artery calcium (CAC) score.

Methods: 

This cross-sectional analysis of pooled data from 3 large cohorts compared the associations between the 3 CKD-EPI eGFR equations (Cr, CysC, and Cr-CysC) with CIMT and CAC score using multivariable regression analysis. eGFR and CIMT were analyzed as continuous variables. CAC scores were analyzed as a binary variable (detectable calcification versus nondetectable) and as a log10 Agatston score in those with detectable CAC.

Results: 

Thousand four hundred eighty-seven participants were included, and of these 910 (562 HIV+ and 348 HIV−) had CIMT measurements and 366 (296 HIV+ and 70 HIV−) had CAC measurements available. In HIV− participants, GFR estimated by any CKD-EPI equation did not significantly correlate with CIMT or CAC scores. When PLWH were analyzed separately including HIV-specific factors, only GFR estimated using Cr-Cys C correlated with CIMT [β= −0.90, 95% CI: (−1.67 to −0.13) μm; P = 0.023]. Similarly, eGFR correlated with Agatston scores only when using cystatin C-based eGFR [β= −8.63, 95% CI: (−16.49 to −0.77) HU; P = 0.034]. Associations between other eGFR formulas and CAC did not reach statistical significance.

Conclusions: 

In PLWH, preclinical atherosclerosis may be more closely correlated with eGFR using formulae that incorporate CysC measurements than Cr alone.



中文翻译:

基于胱抑素C的HIV感染者肾小球滤过率估计值及其与动脉粥样硬化成像标志物的关联

介绍: 

估计的肾小球滤过率降低(eGFR)与HIV感染者(PLWH)患心血管疾病的风险增加相关。尚不清楚结合半胱氨酸蛋白酶抑制剂C(CysC)测量的eGFR方程是否比仅使用肌酐(Cr)的方程更能预测临床前心血管疾病

目标: 

该研究旨在确定3种慢性肾脏病流行病学(CKD-EPI)eGFR方程中,哪一项与颈动脉内膜中层厚度(CIMT)和冠状动脉钙(CAC)评分最相关。

方法: 

这项来自3个大型队列研究的汇总数据的横断面分析使用多元回归分析比较了3个CKD-EPI eGFR方程(Cr,CysC和Cr-CysC)与CIMT和CAC得分之间的关​​联。eGFR和CIMT作为连续变量进行分析。在具有可检测的CAC的患者中,将CAC得分分析为二元变量(可检测的钙化与不可检测)和log10 Agatston得分。

结果: 

包括487名参与者,其中910名(562 HIV +和348 HIV-)进行了CIMT测量,而366名(296 HIV +和70 HIV-)进行了CAC测量。在HIV参与者中,通过任何CKD-EPI方程估算的GFR与CIMT或CAC得分均无显着相关。当单独分析包括艾滋病毒特异性因子在内的PLWH时,只有使用Cr-Cys C估计的GFR与CIMT相关[β= -0.90,95%CI:(-1.67至-0.13)μm;P = 0.023]。类似地,仅当使用基于半胱氨酸蛋白酶抑制剂C的eGFR时,eGFR与Agatston评分相关[β= −8.63,95%CI:(−16.49至-0.77)HU。P= 0.034]。其他eGFR公式与CAC之间的关联未达到统计学意义。

结论: 

在PLWH中,使用结合CysC测量值的公式(而不是单独使用Cr),临床前动脉粥样硬化与eGFR可能更紧密相关。

更新日期:2020-10-30
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