Correcting eGFR for the effects of ART on tubular creatinine secretion: does one size fit all?

Area of Science:

• Pharmacology
• Nephrology
• Infectious Diseases

Background:

• Several antiretroviral drugs, including dolutegravir, rilpivirine, and cobicistat, are known to inhibit tubular creatinine secretion.
• This inhibition leads to a benign increase in serum creatinine levels and a subsequent reduction in the estimated glomerular filtration rate (eGFR).

Purpose of the Study:

• To discuss the magnitude and pattern of eGFR decline caused by these antiretrovirals.
• To evaluate the effectiveness of a standardized correction factor in overcoming these changes.
• To assess the value of serial eGFR measurements and cystatin C as an alternative biomarker for kidney function.

Main Methods:

• This is a commentary discussing existing research and clinical observations.
• It references findings by Brunet et al. in Antiviral Therapy regarding a standardized correction factor.
• It analyzes the utility of serial eGFR measures and cystatin C.

Main Results:

• Antiretroviral-induced eGFR decline is generally benign and predictable.
• A standardized correction factor may help standardize eGFR measurements in patients taking these drugs.
• Serial eGFR monitoring can detect significant declines, and cystatin C offers a potential alternative biomarker.

Conclusions:

• Antiretroviral drug effects on creatinine-based eGFR are well-documented and typically benign.
• Standardized correction factors and serial monitoring are valuable tools for managing kidney function assessment in patients on these medications.
• Cystatin C warrants consideration as a complementary biomarker for kidney function in this population.