Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study

Shelton, Brittany A.; Sawinski, Deirdre; MacLennan, Paul A.; Lee, Wonjun; Wyatt, Christina M.; Nadkarni, Girish N.; Fatima, Huma; Mehta, Shikha; Crane, Heidi M.; Porrett, Paige M.; Julian, Bruce A.; Moore, Richard D.; Christopoulos, Katerina; Jacobson, Jeffrey M.; Muller, Elmi; Eron, Joseph J.; Saag, Michael S.; Peter, Inga; Locke, Jayme E.

doi:10.1016/j.eclinm.2022.101653

Cited by 5 publications

(3 citation statements)

References 82 publications

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“…Variables were retained for model inclusion if they were significant at P less than 0.10 or if they were determined to be clinically meaningful to include in our model. A series of five models were built: a model including race, APOL1 status [34], and African ancestry [23], a model including none of those covariates, and a model containing each of those covariates independently. Model fit was measured through the root mean squared error (RMSE), and the models containing at least one surrogate for race were compared with the model containing none of those covariates.…”

Section: Methodsmentioning

confidence: 99%

“…Ordinary least squares regression was used to determine whether the inclusion of race or surrogates of race, APOL1 variants and genetic African ancestry, improved ability to predict log-transformed serum creatinine. Additional variables considered for model inclusion included age at study entry, birth sex, BMI [32], hypertension [32], diabetes [33], hepatitis C infection [34], hepatitis B infection [34], history of intravenous drug use [35], CD4 þ cell count, log-transformed HIV viral load, tenofovir use, protease inhibitor use, indinavir use, atazanavir use, lopinavir use, integrase inhibitor use, and overall antiretroviral therapy use. Model residuals were assessed for functional form of continuous variables, and all models were tested for collinearity of variables using the variance inflation factor.…”

Section: Linear Regressionmentioning

confidence: 99%

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African American/black race, Apolipoprotein L1, and the indirect glomerular filtration measure serum creatinine among persons living with HIV

Shelton,

Sawinski,

Peter

et al. 2023

Aids

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Objective: Accurate estimation of kidney function is critical among people living with HIV (PLWH) to avoid under-dosing of antiretroviral therapies and ensure timely referral for kidney transplantation. Existing estimation equations for kidney function include race, the appropriateness of which has been debated. Given advancements in understanding of race and the necessity of accuracy in kidney function estimation, this study aimed to examine whether race, or genetic factors, improved prediction of serum creatinine among PLWH. Design: This cross-sectional study utilized data from the Center for AIDS Research Network of Integrated Clinical Systems cohort (2008–2018). The outcome was baseline serum creatinine. Methods: Ordinary least squares regression was used to examine whether inclusion of race or genetic factors (apolipoprotein-L1 (APOL1) variants and genetic African ancestry) improved serum creatinine prediction. A reduction in root mean squared error (RMSE) >2% was a clinically relevant improvement in predictive ability. Results: There were 4,183 PLWH included. Among PLWH whose serum creatinine <1.7 mg/dL, race was significantly associated with serum creatinine (β = 0.06, SE = 0.01, p < 0.001), but did not improve predictive ability. African ancestry and APOL1 variants similarly failed to improve predictive ability. Whereas, when serum creatinine ≥1.7 mg/dL, inclusion of race reduced the RMSE by 2.1%, indicating improvement in predictive ability. APOL1 variants further improved predictive ability by reducing the RMSE by 2.9% Conclusions: These data suggest that, among PLWH, inclusion of race or genetic factors may only be warranted at higher serum creatinine levels. Work eliminating existing healthcare disparities while preserving the utility of estimating equations is needed.

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Section: Methodsmentioning

confidence: 99%

Section: Linear Regressionmentioning

confidence: 99%

African American/black race, Apolipoprotein L1, and the indirect glomerular filtration measure serum creatinine among persons living with HIV

Shelton,

Sawinski,

Peter

et al. 2023

Aids

Self Cite

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“…One noncommunicable disease of pressing concern is kidney disease. Chronic and end-stage kidney disease (ESKD) are leading comorbidities among PWH who may experience increased risk because of HIV viremia, nephrotoxic ART regimens, history of substance use, or co-infection with hepatitis C virus [7,8]. Although PWH experience increased risk of chronic kidney disease and rapid progression to ESKD [9,10], they are less likely to receive a kidney transplant than people without HIV [11].…”

Section: Introductionmentioning

confidence: 99%

Quantifying the association of individual-level characteristics with disparities in kidney transplant waitlist addition among people with HIV

Shelton,

Sen,

Becker

et al. 2023

Aids

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Background: Over 45% of people with HIV (PWH) in the United States ≥50 years old and are at heightened risk of aging-related comorbidities including end-stage kidney disease (ESKD), for which kidney transplant is the optimal treatment. Among ESKD patients, PWH have lower likelihood of waitlisting, a requisite step in the transplant process, than individuals without HIV. It is unknown what proportion of the inequity by HIV-status can be explained by demographics, medical characteristics, substance use history, and geography. Methods: The United States Renal Data System, a national database of all individuals ESKD, was used to create a cohort of people with and without HIV through Medicare claims linkage (2007–2017). The primary outcome was waitlisting. Inverse odds ratio weighting was conducted to assess what proportion of the disparity by HIV-status could be explained by individual characteristics. Results: 6,250 PWH were significantly younger at ESKD diagnosis and more commonly Black with fewer comorbidities. PWH were more frequently characterized as using tobacco, alcohol, and drugs. Positive HIV-status was associated with 57% lower likelihood of waitlisting (adjusted hazard ratio [aHR]: 0.43, 95% confidence interval [CI]: 0.46–0.48, p < 0.001). Controlling for demographics, medical characteristics, substance use, and geography explained 39.8% of this observed disparity (aHR: 0.69, 95% CI: 0.59–0.79, p < 0.001). Conclusions: PWH were significantly less likely to be waitlisted, and 60.2% of that disparity remained unexplained. HIV characteristics such as CD4 counts, viral loads, antiretroviral therapy adherence, as well as patient preferences and provider decision-making warrant further study.

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HIV and CKD in the Tenofovir Era: A Prospective Parallel-Group Cohort Study From Tanzania

Roberts,

Fadhil,

Willkens

et al. 2025

Kidney Medicine

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Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study

Cited by 5 publications

References 82 publications

African American/black race, Apolipoprotein L1, and the indirect glomerular filtration measure serum creatinine among persons living with HIV

African American/black race, Apolipoprotein L1, and the indirect glomerular filtration measure serum creatinine among persons living with HIV

Quantifying the association of individual-level characteristics with disparities in kidney transplant waitlist addition among people with HIV

HIV and CKD in the Tenofovir Era: A Prospective Parallel-Group Cohort Study From Tanzania

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