Comparison of cystatin C and creatinine to determine the incidence of composite adverse outcomes in HIV-infected individuals

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 21; no. 2; pp. 84 - 89
• Main Authors: Yanagisawa, Naoki, Sasaki, Shugo, Suganuma, Akihiko, Imamura, Akifumi, Ajisawa, Atsushi, Ando, Minoru
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2015
• Subjects: Adult; Biomarkers - blood; Cardiovascular disease; Creatinine - blood; Cystatin C; Cystatin C - blood; Estimated glomerular filtration; Female; Glomerular Filtration Rate; Hematology, Oncology and Palliative Medicine; HIV; HIV Infections - blood; HIV Infections - physiopathology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Prospective Studies; Proteinuria; Proteinuria - virology; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - virology; Cardiovascular disease; HIV; Estimated glomerular filtration; Mortality; Cystatin C; Proteinuria
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2014.10.006

Abstract Background Cystatin C is an overall biomarker of pathophysiologic abnormalities that accompany chronic kidney disease (CKD). The utility of cystatin C is not fully understood in an HIV-infected population. Methods This prospective study investigated 661 HIV-infected individuals for 4 years to determine the incidence of adverse outcomes, including all-cause mortality, cardiovascular disease, and renal dysfunction. The risk of developing the outcomes was discriminated with a 4 color-coded classification in a 3 × 6 contingency table, that combined 3 grades of dipstick proteinuria with 6 grades of estimated glomerular filtration rate (eGFR) calculated using either serum creatinine (eGFRcr) or cystatin C (eGFRcy): green, low risk; yellow, moderately increased risk; orange, high risk; and red, very high risk. The cumulative incidence of the outcomes was assessed by the Kaplan–Meier method, and the association between color-coded risk and the time to outcome was evaluated using multivariate proportional hazards analysis. Results Compared with eGFRcr, the use of eGFRcy reduced the prevalence of risk ≥orange by 0.8%. The adverse outcomes were significantly more likely to occur to the patients with baseline risk category ≥orange than those with ≤yellow, independent of risk categories based on eGFRcr or eGFRcy. However, in multivariate analysis, risk category ≥orange with eGFRcy-based classification was significantly associated with adverse outcomes, but not the one with eGFRcr. Conclusions Replacing creatinine by cystatin C in the CKD color-coded risk classification may be appropriate to discriminate HIV-infected patients at increased risk of a poor prognosis.