Cystatin C-based renal function changes after antiretroviral initiation

A substudy of a randomized trial

Samir Gupta, Douglas Kitch, Camlin Tierney, Eric S. Daar, Paul E. Sax, Kathleen Melbourne, Belinda Ha, Grace A. McComsey

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background. The effects of antiretrovirals on cystatin C-based renal function estimates are unknown. Methods. We analyzed changes in renal function using creatinine and cystatin C-based estimating equations in 269 patients in A5224s, a substudy of study A5202, in which treatment-naive patients were randomized to abacavir/lamivudine or tenofovir/emtricitabine with open-label atazanavir/ritonavir or efavirenz. Results. Changes in renal function significantly improved (or declined less) with abacavir/lamivudine treatment compared with tenofovir/emtricitabine using the Cockcroft-Gault formula (P =.016) and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI; P =.030) and 2012 CKD-EPI cystatin C-creatinine (P =.025). Renal function changes significantly improved (or declined less) with efavirenz compared with atazanavir/ritonavir (P <.001 for all equations). Mean (95% confidence interval) renal function changes specifically for tenofovir/emtricitabine combined with atazanavir/ritonavir were -8.3 (-14.0, -2.6) mL/min with Cockcroft-Gault; -14.9 (-19.7, -10.1) mL/min per 1.732 with Modification of Diet in Renal Disease; -12.8 (-16.5, -9.0) mL/min per 1.732 with 2009 CKD-EPI; +8.9 (4.2, 13.7) mL/min per 1.732 with 2012 CKD-EPI cystatin C; and -1.2 (-5.1, 2.6) mL/min per 1.732 with 2012 CKD-EPI cystatin C-creatinine. Renal function changes for the other treatment arms were more favorable but similarly varied by estimating equation. Conclusions. Antiretroviral-associated changes in renal function vary in magnitude and direction based on the estimating equation used.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Volume1
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Cystatin C
Tenofovir
Kidney
efavirenz
Ritonavir
Creatinine
Diet Therapy
Chronic Renal Insufficiency
Epidemiology
Therapeutics
Confidence Intervals

Keywords

  • Atazanavir
  • Creatinine
  • Cystatin C
  • HIV-1
  • Nephropathy
  • Tenofovir

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Cystatin C-based renal function changes after antiretroviral initiation : A substudy of a randomized trial. / Gupta, Samir; Kitch, Douglas; Tierney, Camlin; Daar, Eric S.; Sax, Paul E.; Melbourne, Kathleen; Ha, Belinda; McComsey, Grace A.

In: Open Forum Infectious Diseases, Vol. 1, No. 1, 2014.

Research output: Contribution to journalArticle

Gupta, Samir ; Kitch, Douglas ; Tierney, Camlin ; Daar, Eric S. ; Sax, Paul E. ; Melbourne, Kathleen ; Ha, Belinda ; McComsey, Grace A. / Cystatin C-based renal function changes after antiretroviral initiation : A substudy of a randomized trial. In: Open Forum Infectious Diseases. 2014 ; Vol. 1, No. 1.
@article{18e9331fcda4441488aa0eec0814fbba,
title = "Cystatin C-based renal function changes after antiretroviral initiation: A substudy of a randomized trial",
abstract = "Background. The effects of antiretrovirals on cystatin C-based renal function estimates are unknown. Methods. We analyzed changes in renal function using creatinine and cystatin C-based estimating equations in 269 patients in A5224s, a substudy of study A5202, in which treatment-naive patients were randomized to abacavir/lamivudine or tenofovir/emtricitabine with open-label atazanavir/ritonavir or efavirenz. Results. Changes in renal function significantly improved (or declined less) with abacavir/lamivudine treatment compared with tenofovir/emtricitabine using the Cockcroft-Gault formula (P =.016) and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI; P =.030) and 2012 CKD-EPI cystatin C-creatinine (P =.025). Renal function changes significantly improved (or declined less) with efavirenz compared with atazanavir/ritonavir (P <.001 for all equations). Mean (95{\%} confidence interval) renal function changes specifically for tenofovir/emtricitabine combined with atazanavir/ritonavir were -8.3 (-14.0, -2.6) mL/min with Cockcroft-Gault; -14.9 (-19.7, -10.1) mL/min per 1.732 with Modification of Diet in Renal Disease; -12.8 (-16.5, -9.0) mL/min per 1.732 with 2009 CKD-EPI; +8.9 (4.2, 13.7) mL/min per 1.732 with 2012 CKD-EPI cystatin C; and -1.2 (-5.1, 2.6) mL/min per 1.732 with 2012 CKD-EPI cystatin C-creatinine. Renal function changes for the other treatment arms were more favorable but similarly varied by estimating equation. Conclusions. Antiretroviral-associated changes in renal function vary in magnitude and direction based on the estimating equation used.",
keywords = "Atazanavir, Creatinine, Cystatin C, HIV-1, Nephropathy, Tenofovir",
author = "Samir Gupta and Douglas Kitch and Camlin Tierney and Daar, {Eric S.} and Sax, {Paul E.} and Kathleen Melbourne and Belinda Ha and McComsey, {Grace A.}",
year = "2014",
doi = "10.1093/ofid/ofu003",
language = "English (US)",
volume = "1",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Cystatin C-based renal function changes after antiretroviral initiation

T2 - A substudy of a randomized trial

AU - Gupta, Samir

AU - Kitch, Douglas

AU - Tierney, Camlin

AU - Daar, Eric S.

AU - Sax, Paul E.

AU - Melbourne, Kathleen

AU - Ha, Belinda

AU - McComsey, Grace A.

PY - 2014

Y1 - 2014

N2 - Background. The effects of antiretrovirals on cystatin C-based renal function estimates are unknown. Methods. We analyzed changes in renal function using creatinine and cystatin C-based estimating equations in 269 patients in A5224s, a substudy of study A5202, in which treatment-naive patients were randomized to abacavir/lamivudine or tenofovir/emtricitabine with open-label atazanavir/ritonavir or efavirenz. Results. Changes in renal function significantly improved (or declined less) with abacavir/lamivudine treatment compared with tenofovir/emtricitabine using the Cockcroft-Gault formula (P =.016) and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI; P =.030) and 2012 CKD-EPI cystatin C-creatinine (P =.025). Renal function changes significantly improved (or declined less) with efavirenz compared with atazanavir/ritonavir (P <.001 for all equations). Mean (95% confidence interval) renal function changes specifically for tenofovir/emtricitabine combined with atazanavir/ritonavir were -8.3 (-14.0, -2.6) mL/min with Cockcroft-Gault; -14.9 (-19.7, -10.1) mL/min per 1.732 with Modification of Diet in Renal Disease; -12.8 (-16.5, -9.0) mL/min per 1.732 with 2009 CKD-EPI; +8.9 (4.2, 13.7) mL/min per 1.732 with 2012 CKD-EPI cystatin C; and -1.2 (-5.1, 2.6) mL/min per 1.732 with 2012 CKD-EPI cystatin C-creatinine. Renal function changes for the other treatment arms were more favorable but similarly varied by estimating equation. Conclusions. Antiretroviral-associated changes in renal function vary in magnitude and direction based on the estimating equation used.

AB - Background. The effects of antiretrovirals on cystatin C-based renal function estimates are unknown. Methods. We analyzed changes in renal function using creatinine and cystatin C-based estimating equations in 269 patients in A5224s, a substudy of study A5202, in which treatment-naive patients were randomized to abacavir/lamivudine or tenofovir/emtricitabine with open-label atazanavir/ritonavir or efavirenz. Results. Changes in renal function significantly improved (or declined less) with abacavir/lamivudine treatment compared with tenofovir/emtricitabine using the Cockcroft-Gault formula (P =.016) and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI; P =.030) and 2012 CKD-EPI cystatin C-creatinine (P =.025). Renal function changes significantly improved (or declined less) with efavirenz compared with atazanavir/ritonavir (P <.001 for all equations). Mean (95% confidence interval) renal function changes specifically for tenofovir/emtricitabine combined with atazanavir/ritonavir were -8.3 (-14.0, -2.6) mL/min with Cockcroft-Gault; -14.9 (-19.7, -10.1) mL/min per 1.732 with Modification of Diet in Renal Disease; -12.8 (-16.5, -9.0) mL/min per 1.732 with 2009 CKD-EPI; +8.9 (4.2, 13.7) mL/min per 1.732 with 2012 CKD-EPI cystatin C; and -1.2 (-5.1, 2.6) mL/min per 1.732 with 2012 CKD-EPI cystatin C-creatinine. Renal function changes for the other treatment arms were more favorable but similarly varied by estimating equation. Conclusions. Antiretroviral-associated changes in renal function vary in magnitude and direction based on the estimating equation used.

KW - Atazanavir

KW - Creatinine

KW - Cystatin C

KW - HIV-1

KW - Nephropathy

KW - Tenofovir

UR - http://www.scopus.com/inward/record.url?scp=84975283681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975283681&partnerID=8YFLogxK

U2 - 10.1093/ofid/ofu003

DO - 10.1093/ofid/ofu003

M3 - Article

VL - 1

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

SN - 2328-8957

IS - 1

ER -