Changing Trends in the Survival of Dialysis Patients with Human Immunodeficiency Virus in the United States

Abstract

ABSTRACT. HIV-infected patients with end-stage renal disease have a very high morbidity and mortality. In the last decade, survival of HIV-infected patients in the United States has remarkably improved. To determine whether similar improvement in survival has occurred in HIV-infected dialysis patients, their survival was evaluated by using the United States Renal Data System database. Survival of HIV-infected dialysis patients in the United States was determined and the influence of year of initiation of dialysis, and demographic characteristics on the survival were analyzed by the Kaplan-Meier method. The effects of above variables on survival were also examined in a Cox proportional hazards model. Identified were 6166 HIV-infected patients with end-stage renal disease who received dialysis in the United States. Eighty-nine percent of the patients were black, 7.4% white, and 3% other. From 1990 to 1999, 1-yr survival of HIV-infected patients on dialysis improved from 56 to 74%, and the annual death rates declined from 458 deaths to 240 deaths per 1000 patient-years. The hazard ratio declined significantly in patients who initiated dialysis in years 1999-2000 compared with patients who initiated dialysis ≤ 1990 (hazard ratio, 0.49; 95% confidence interval, 0. 40 to 0.60). Survival of HIV-infected dialysis patients has remarkably improved in the United States.

Racial Differences in End-Stage Renal Disease Rates in HIV Infection versus Diabetes

“…8 -11 Similarly, studies using ESRD registry data demonstrate that approximately 88% of all cases of ESRD in the HIVinfected population occur among black individuals. 6,12,13 Collectively, these reports support the racial disparity in ESRD incidence among HIV-infected patients reported here. Incidence rates of ESRD that were observed in our study among HIV-infected patients are comparable to the indirect estimates obtained by Eggers and Kimmel.…”

Update on kidney transplantation in human immunodeficiency virus infected recipients

“…According to Medicare claims data, the number of prevalent HIV positive ESRD patients has increased more than 14-fold from 1999 to 2010 [9] . Outcomes of HIV infected dialysis patients have improved dramatically [8,9] .…”

“…Outcomes of HIV infected dialysis patients have improved dramatically [8,9] . Actual number of HIV positive patients who received kidney transplants or who are on the waiting list is unknown.…”

Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review

“…For example, HIV-infected individuals constituted up to 40% of dialysis patients in urban centers in the pre-HAART era [5]. Based on a 2002 study on survival among HIV-infected individuals using the United States Renal Data System (USRDS), a national database system that collects, analyzes, and distributes information about end-stage renal disease in the United States, 6179 individuals with HIVAN or HIV infection on dialysis were identified [6]. USRDS comprises more than 90% of the individuals requiring hemodialysis in the United States [7].…”

“…African Americans account for the majority of patients with HIV infection undergoing hemodialysis [2,4]. Antiretroviral therapy has shown survival benefits in HIV individuals [8], including patient undergoing hemodialysis; however, the overall survival is still lower than HIV-negative individuals on dialysis [6]. Since diabetes and cardiovascular disease are increasing among the HIV-infected population [9], a higher number of these patients suffering from chronic kidney disease, including end-stage renal disease, is expected.…”