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：

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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。