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The validity of the modification of diet in renal disease formula in HIV-infected patients: a systematic review

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Abstract

Rationale, aims and objectives

Renal dysfunction is highly prevalent in HIV-infected patients and may require dose adjustment of renally excreted antiretroviral drugs. The Modification of Diet in Renal Disease (MDRD)-4 formula is frequently used in daily practice to estimate patients’ renal function. The aim of this systematic review was to assess the validity of the MDRD-4 formula in HIV-infected patients.

Method

A systematic search in Pubmed and EMBASE was done to identify studies which compared MDRD-4 with measured glomerular filtration rate (mGFR) in HIV-infected patients.

Results

Five studies were included, which provided data from 464 HIV-infected patients with mean mGFR ranging from 87 to 118 ml/min/1.73 m2. In all studies, results from the MDRD-4 gave an underestimation of the mGFR. Mean bias ((MDRD-4) − mGFR) ranged from −6 to −11 ml/min/1.73 m2 across studies. The accuracy expressed in terms of P 30 ranged from 64 to 89 %.

Conclusions

The MDRD-4 formula is as valid in HIV-positive as in HIV-negative patients. Because the available studies comprised mainly HIV-infected patients with mildly impaired to good renal function (GFR ≥ 60 ml/min/1.73 m2), more research is needed to validate the MDRD-4 formula in HIV-infected patients with moderate to severe renal impairment.

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Author information

Authors and Affiliations

  1. Hospital Pharmacy ‘ZANOB’, ‘s-Hertogenbosch, The Netherlands

    Willemijn L. Eppenga & Hieronymus J. Derijks

  2. Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Willemijn L. Eppenga, Peter A. G. M. De Smet & Michel Wensing

  3. Department of Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Matthijs van Luin & Peter A. G. M. De Smet

  4. Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands

    Matthijs van Luin

  5. Department of Clinical Pharmacy, Rijnstate Hospital, Arnhem, The Netherlands

    Matthijs van Luin

  6. Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    Clemens Richter

  7. Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands

    Hieronymus J. Derijks

Authors
  1. Willemijn L. Eppenga
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Corresponding author

Correspondence to Willemijn L. Eppenga.

Appendix

Appendix

Search terms

The following search terms were used:

Assessment of the renal function

  1. (a)

    Glomerular filtration rate and creatinine

Reliability

  1. (b)

    “Predictive Value of Tests” [Mesh] OR “Reference Values” [Mesh] OR predictive value* OR reference value*

  2. (c)

    limitation OR limitations

  3. (d)

    pitfalls OR pitfall

  4. (e)

    overestimated OR underestimated OR underestimation OR overestimation OR overestimating OR underestimating

  5. (f)

    disturbance OR interference

  6. (g)

    “diagnostic errors” [MeSH Terms] OR (diagnostic AND errors)

  7. (h)

    “sensitivity and specificity” [MeSH Terms] OR sensitivity OR specificity

  8. (i)

    marker OR markers OR “Biological Markers” [Mesh]

  9. (j)

    accurate OR inaccurate OR inaccuracy OR accuracy

Creatinine-based formulas

  1. (k)

    (cockcroft AND gault) OR cockcroft-gault OR MDRD OR (modification AND diet) OR “kidney diseases” [MeSH Terms] OR (kidney AND diseases) OR renal disease

Date of publication

  1. (l)

    2000—current (August 2012)

Diagnosis

  1. (m)

    Human immunodeficiency virus OR “HIV” [MeSH Terms] OR HIV

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Eppenga, W.L., van Luin, M., Richter, C. et al. The validity of the modification of diet in renal disease formula in HIV-infected patients: a systematic review. J Nephrol 27, 11–18 (2014). https://doi.org/10.1007/s40620-013-0012-5

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  • DOI: https://doi.org/10.1007/s40620-013-0012-5

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