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Cystatin C level as a marker of kidney function in human immunodeficiency virus infection: the FRAM study

Michelle C Odden1, Rebecca Scherzer, Peter Bacchetti

  • 1Department of Medicine, San FranciscoVeterans Affairs Medical Center 4150 Clement Street, San Francisco, CA 94121, USA.

Archives of Internal Medicine
|November 14, 2007
PubMed

Insights

Human immunodeficiency virus (HIV) infection is linked to worse kidney function, as indicated by elevated cystatin C levels. This marker may help identify HIV patients at higher risk for kidney and cardiovascular diseases.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Biomarkers

Background:

  • Studies indicate a high prevalence of end-stage renal disease in individuals with human immunodeficiency virus (HIV).
  • Moderate kidney function impairments in HIV-infected persons are less understood.
  • Cystatin C may be a more sensitive marker than creatinine for detecting kidney dysfunction in HIV patients.

Purpose of the Study:

  • To evaluate kidney function in HIV-infected individuals using cystatin C and creatinine.
  • To compare kidney function markers between HIV-infected persons and controls.

Main Methods:

  • Kidney function was assessed in 1008 HIV-infected individuals and 290 controls from the FRAM and CARDIA studies.
  • Cystatin C and creatinine levels were measured.
  • Estimated glomerular filtration rates (eGFR) were calculated.

Main Results:

  • HIV-infected individuals had significantly higher mean cystatin C levels (0.92 +/- 0.22 mg/L) compared to controls (0.76 +/- 0.15 mg/L).
  • Mean creatinine levels and eGFR were similar between HIV-infected individuals and controls.
  • HIV-infected individuals were more likely to have cystatin C levels >1.0 mg/L, a threshold associated with increased mortality and disease risk.

Conclusions:

  • HIV infection is associated with substantially worse kidney function when measured by cystatin C, despite similar creatinine-based measures.
  • Cystatin C measurement can identify HIV-infected individuals at increased risk for kidney and cardiovascular diseases.
  • Factors like hypertension, low HDL, HCV coinfection, and lower CD4 count were associated with higher cystatin C levels in HIV patients.
Abstract

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