Cystatin C-based renal function changes after antiretroviral initiation: a substudy of a randomized trial.

TitleCystatin C-based renal function changes after antiretroviral initiation: a substudy of a randomized trial.
Publication TypeJournal Article
Year of Publication2014
AuthorsGupta SK, Kitch D, Tierney C, Daar ES, Sax PE, Melbourne K, Ha B, McComsey GA
Corporate AuthorsAIDS Clinical Trials Group Study A5224s Team
JournalOpen Forum Infect Dis
Volume1
Issue1
Paginationofu003
Date Published2014 Mar
ISSN2328-8957
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 1.73(2) with Modification of Diet in Renal Disease; -12.8 (-16.5, -9.0) mL/min per 1.73(2) with 2009 CKD-EPI; +8.9 (4.2, 13.7) mL/min per 1.73(2) with 2012 CKD-EPI cystatin C; and -1.2 (-5.1, 2.6) mL/min per 1.73(2) 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.

DOI10.1093/ofid/ofu003
Alternate JournalOpen Forum Infect Dis
PubMed ID25734077
PubMed Central IDPMC4324191
Grant ListUM1 AI068634 / AI / NIAID NIH HHS / United States