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The FRAM Study

Michelle C. Odden, MS; Rebecca Scherzer, PhD; Peter Bacchetti, PhD; Lynda Anne Szczech, MD, MSCE; Stephen Sidney, MD; Carl Grunfeld, MD, PhD; Michael G. Shlipak, MD, MPH

Arch Intern Med. 2007;167(20):2213-2219.

Background  Although studies have reported a high prevalence of end-stage renal disease in human immunodeficiency virus (HIV)-infected individuals, little is known about moderate impairments in kidney function. Cystatin C measurement may be more sensitive than creatinine for detecting impaired kidney function in persons with HIV.

Methods  We evaluated kidney function in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) cohort, a representative sample of 1008 HIV-infected persons and 290 controls from the Coronary Artery Risk Development in Young Adults (CARDIA) study in the United States.

Results  Cystatin C level was elevated in HIV-infected individuals; the mean ± SD cystatin C level was 0.92 ± 0.22 mg/L in those infected with HIV and 0.76 ± 0.15 mg/L in controls (P < .001). In contrast, both mean creatinine levels and estimated glomerular filtration rates appeared similar in HIV-infected individuals and controls (0.87 ± 0.21 vs 0.85 ± 0.19 mg/dL [to convert to micromoles per liter, multiply by 88.4] [P = .35] and 110 ± 26 vs 106 ± 23 mL/min/1.73 m² [P = .06], respectively). Persons with HIV infection were more likely to have a cystatin C level greater than 1.0 mg/L (OR, 9.8; 95% confidence interval, 4.4-22.0 [P <.001]), a threshold demonstrated to be associated with increased risk for death and cardiovascular and kidney disease. Among participants with HIV, potentially modifiable risk factors for kidney disease, hypertension, and low high-density lipoprotein concentration were associated with a higher cystatin C level, as were lower CD4 lymphocyte count and coinfection with hepatitis C virus (all P < .001).

Conclusions  Individuals infected with HIV had substantially worse kidney function when measured by cystatin C level compared with HIV-negative controls, whereas mean creatinine levels and estimated glomerular filtration rates were similar. Cystatin C measurement could be a useful clinical tool to identify HIV-infected persons at increased risk for kidney and cardiovascular disease.

Author Affiliations: Department of Medicine (Ms Odden and Dr Shlipak) and Metabolism Section (Drs Scherzer, Bacchetti, and Grunfeld), San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Epidemiology, University of California, Berkeley (Ms Odden); Department of Epidemiology and Biostatistics, University of California, San Francisco (Drs Bacchetti, Grunfeld, and Shlipak); Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC (Dr Szczech); and Kaiser Permanente Northern California Division of Research, Oakland (Dr Sidney).

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