当前位置： SCI文献检索 > ANTIVIRAL THERAPY期刊下所有文献 > Assessing bias introduced in estimated glomerular filtration rate (eGFR) by the inhibition of creatinine tubular secretion from common antiretrovirals.

Assessing bias introduced in estimated glomerular filtration rate (eGFR) by the inhibition of creatinine tubular secretion from common antiretrovirals.

Abstract：

BACKGROUND:Researchers must often rely on creatinine measurements to assess kidney function because direct glomerular filtration rates (GFR) and cystatin-c are rarely measured in routine clinical settings. However, HIV treatments often include dolutegravir, raltegravir, rilpivirine or cobicistat, which inhibit the proximal tubular secretion of creatinine without impairing kidney function, thus leading to measurement bias when using creatinine-based estimated GFR (eGFR). We developed eGFR correction factors to account for this potential bias. METHODS:11,359 treatment-naïve HIV-positive individuals in OPERA were included if they initiated dolutegravir, elvitegravir/cobicistat, darunavir/cobicistat, raltegravir, rilpivirine, or efavirenz (control) with an eGFR >60 ml/min/1.73m2. The eGFR was corrected by adding the median decrease reported in the literature to the calculated eGFR; correction factors were not validated. Incidence rates of eGFR <60 ml/min/1.73m2 (Poisson regression) and the relationship between regimens and eGFR <60 ml/min/1.73m2 (multivariate Cox proportional hazards models) were estimated with and without eGFR correction. RESULTS:Without eGFR correction, dolutegravir, elvitegravir/cobicistat, darunavir/cobicistat, raltegravir and rilpivirine based regimens were statistically significantly associated with a higher likelihood of eGFR <60 ml/min/1.73m2 than efavirenz. With eGFR correction, each of these regimens was associated with a statistically significantly lower likelihood of eGFR <60 ml/min/1.73m2 compared to efavirenz. CONCLUSIONS:With increasing use of agents that inhibit tubular creatinine secretion, artificially low eGFR values could lead to erroneous conclusions in studies of HIV treatment and kidney outcomes measured with creatinine-based eGFR equations. Sensitivity analyses assessing the potential magnitude of bias arising from creatinine secretion inhibition should be performed.

journal_name

Antivir Ther

journal_title

Antiviral therapy

authors

Brunet L,Wyatt C,Hsu R,Mounzer K,Fusco J,Fusco G

doi

10.3851/IMP3373

subject

Has Abstract

pub_date

2020-11-19 00:00:00

eissn

1359-6535

issn

2040-2058

pub_type

杂志文章

在线工具

Assessing bias introduced in estimated glomerular filtration rate (eGFR) by the inhibition of creatinine tubular secretion from common antiretrovirals.