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J Infect Chemother. 2018 Mar;24(3):199-205. doi: 10.1016/j.jiac.2017.10.015. Epub 2017 Nov 14.

Clinical benefits of using inulin clearance and cystatin C for determining glomerular filtration rate in HIV-1-infected individuals treated with dolutegravir.

Author information

1
Department of Advanced Medicine for HIV Infection, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan. Electronic address: yukawa@onh.go.jp.
2
Department of Advanced Medicine for HIV Infection, Osaka University Graduate School of Medicine, Osaka, Japan; AIDS Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.
3
Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan.

Abstract

INTRODUCTION:

Dolutegravir may inhibit creatinine transporters in renal tubules and elevate serum creatinine levels. We investigated the usefulness of glomerular filtration rate (GFR) measured using inulin clearance (Cin), creatinine clearance (Ccr), and estimated GFR based on both serum creatinine (eGFRcre) and serum cystatin C (eGFRcys).

PATIENTS & METHODS:

HIV-1-infected Japanese patients with suppressed viremia and whose antiretroviral drug was switched to dolutegravir from other drugs were included (n = 108, Study 1). We compared eGFRcre and eGFRcys at the start and after 48 weeks of dolutegravir administration. For the patients providing consent, we measured Cin and Ccr (n = 15, Study 2). We assessed biases and accuracy and compared Cin with eGFRcre, eGFRcys, and Ccr.

RESULTS:

There were no differences in serum cystatin C and eGFRcys between baseline and at 48 weeks. Moreover, eGFRcre was significantly less accurate (within 30% of measured GFR) than both eGFRcys and Ccr (40% accuracy compared to 93% and 93%, respectively). eGFRcys was significantly less biased than eGFRcre and Ccr (p < 0.0001, p = 0.00036, respectively). No significant difference between Cin and eGFRcys was observed. eGFRcys was significantly correlated with Cin (γ = 0.85, p < 0.0001).

CONCLUSIONS:

eGFRcys provided the most precise estimate and most closely approximate Cin in HIV-1-infected Japanese patients with suppressed viremia treated with dolutegravir. We demonstrated clinical benefits of inulin clearance and eGFRcys. This is the first study performing inulin clearance for HIV-1-infected individuals and to show data for eGFRcys from a large cohort following a switch to dolutegravir from other antiretroviral agents.

KEYWORDS:

Cystatin C; Estimated glomerular filtration rate equation; HIV-1; Inulin clearance

PMID:
29150412
DOI:
10.1016/j.jiac.2017.10.015
[Indexed for MEDLINE]
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