A comparison of estimated glomerular filtration rates using Cockcroft-Gault and the Chronic Kidney Disease Epidemiology Collaboration estimating equations in HIV infection

A Mocroft, L Ryom, P Reiss, H Furrer, A D'Arminio Monforte, J Gatell, S de Wit, M Beniowski, J D Lundgren, O Kirk, EuroSIDA in EuroCOORD, A Mocroft, L Ryom, P Reiss, H Furrer, A D'Arminio Monforte, J Gatell, S de Wit, M Beniowski, J D Lundgren, O Kirk, EuroSIDA in EuroCOORD

Abstract

Objectives: The aim of this study was to determine whether the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)- or Cockcroft-Gault (CG)-based estimated glomerular filtration rates (eGFRs) performs better in the cohort setting for predicting moderate/advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD).

Methods: A total of 9521 persons in the EuroSIDA study contributed 133 873 eGFRs. Poisson regression was used to model the incidence of moderate and advanced CKD (confirmed eGFR < 60 and < 30 mL/min/1.73 m(2) , respectively) or ESRD (fatal/nonfatal) using CG and CKD-EPI eGFRs.

Results: Of 133 873 eGFR values, the ratio of CG to CKD-EPI was ≥ 1.1 in 22 092 (16.5%) and the difference between them (CG minus CKD-EPI) was ≥ 10 mL/min/1.73 m(2) in 20 867 (15.6%). Differences between CKD-EPI and CG were much greater when CG was not standardized for body surface area (BSA). A total of 403 persons developed moderate CKD using CG [incidence 8.9/1000 person-years of follow-up (PYFU); 95% confidence interval (CI) 8.0-9.8] and 364 using CKD-EPI (incidence 7.3/1000 PYFU; 95% CI 6.5-8.0). CG-derived eGFRs were equal to CKD-EPI-derived eGFRs at predicting ESRD (n = 36) and death (n = 565), as measured by the Akaike information criterion. CG-based moderate and advanced CKDs were associated with ESRD [adjusted incidence rate ratio (aIRR) 7.17; 95% CI 2.65-19.36 and aIRR 23.46; 95% CI 8.54-64.48, respectively], as were CKD-EPI-based moderate and advanced CKDs (aIRR 12.41; 95% CI 4.74-32.51 and aIRR 12.44; 95% CI 4.83-32.03, respectively).

Conclusions: Differences between eGFRs using CG adjusted for BSA or CKD-EPI were modest. In the absence of a gold standard, the two formulae predicted clinical outcomes with equal precision and can be used to estimate GFR in HIV-positive persons.

Keywords: chronic kidney disease; eGFR; end stage renal disease; renal function.

© 2013 British HIV Association.

Figures

Figure 1
Figure 1
Bland−Altman plot of differences between estimated glomerular filtration rates (eGFRs) calculated using Cockcroft−Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI).
Figure 2
Figure 2
Moderate and advanced chronic kidney disease (CKD) as predictors of fatal and nonfatal end-stage renal disease (ESRD) and mortality. Moderate (Mod.) CKD [confirmed (> 3 months apart) estimated glomerular filtration rate (eGFR) 2] and advanced (Adv.) CKD (confirmed eGFR < 30 mL/min/1.73 m2) are included as time-updated variables. *Multivariate models adjusted for gender, race, ethnic origin, region, CD4 count nadir and baseline date as fixed baseline covariates and hepatitis B, hepatitis C, prior AIDS diagnosis, prior non-AIDS-related event (pancreatitis, malignancy and end-stage liver disease for ESRD (and additionally ESRD for mortality), cardiovascular event, diabetes, hypertension, smoking status, anaemia, starting combination antiretroviral therapy, CD4 count, viral load and age as time-updated variables. BSA, body surface area; CG, Cockcroft−Gault; CI, confidence interval; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration.

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