Chronic Kidney Disease Incidence, and Progression to End‐Stage Renal Disease, in HIV‐Infected Individuals: A Tale of Two Races

Lucas, Gregory M.; Lau, Bryan; Atta, Mohamed G.; Fine, Derek M.; Keruly, Jeanne C.; Moore, Richard D.

doi:10.1086/587994

Cited by 192 publications

(213 citation statements)

References 29 publications

Supporting

Mentioning

192

Contrasting

Unclassified

Order By: Relevance

“…As has previously been reported, several factors were associated with low eGFR, including BMI, hypertension, HCV infection, tuberculosis, or cryptococcosis, as shown in Table 1 (2,(10)(11)(12)(13)(14). However, after adjustment using multivariate logistic regression, these factors were no longer significantly associated with eGFR ＜ 90.…”

Section: Close Monitoring Of Egfr Should Be Performed In Hiv-infectedsupporting

confidence: 52%

Close Monitoring of eGFR Should Be Performed in HIV-Infected Patients Aged over 37 Years

et al. 2017

View full text Add to dashboard Cite

Section: Close Monitoring Of Egfr Should Be Performed In Hiv-infectedsupporting

confidence: 52%

Close Monitoring of eGFR Should Be Performed in HIV-Infected Patients Aged over 37 Years

et al. 2017

View full text Add to dashboard Cite

“…As previously described [41][42], traditional risk factors associated with renal damage in the HIV-negative population, such as female gender, older age, and diabetes and/or hypertension, as well as CD4 cell count, were associated with a greater risk of a low eGFR value while patients remained untreated. This finding seems to support the view that ageing and metabolic complications in HIV-positive populations are additional factors to consider in the clinical management of these patients [40][41][42].…”

Section: Discussionmentioning

confidence: 56%

“…Nevertheless, beyond simply identifying the existence of this potential toxicity, the key clinical questions are which patients are at the highest risk of renal dysfunction and what is the best time to monitor the emergence of this toxicity. The answers to these questions remain largely unknown because the relationship between the development and progression of renal dysfunction and cART exposure in HIV-infected patients is currently poorly understood [36][37][38][39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of glomerular filtration rate in HIV-1-infected patients before and after combined antiretroviral therapy exposure*

et al. 2010

View full text Add to dashboard Cite

The prevalence and factors associated with an increased risk of renal dysfunction in HIV-infected patients receiving or not receiving antiretroviral therapy (ART) have been poorly evaluated in observational settings. MethodsPatients in the ICONA Foundation cohort with at least two creatinine values available while still ART-naïve were enrolled in the study. A logistic regression analysis was performed to identify predictors of an estimated glomerular filtration rate (eGFR)o90 mL/min/1.73 m 2 at baseline. The incidence and predictors of a 420% reduction in eGFR from pre-combination ART (cART) levels (or a decrease from ! 90 to o90 mL/min/1.73 m 2 ) were evaluated by Poisson regression. ResultsA total of 1505 patients were included in the study; 363 (24%) had eGFRo90 mL/min/1.73 m 2 at baseline. Older patients [odds ratio (OR) 1.58 per 10 years older; Po0.00001], female patients (OR 2.41 vs. male patients; Po0.00001), those who had diabetes and/or hypertension (OR 2.36 vs. neither; Po0.03) and patients with higher baseline CD4 count (OR 1.06 per 100 cells/mL higher; Po0.03) showed a greater risk of eGFRo90 mL/min/1.73 m 2 . Ninety-six patients experienced an eGFR decrease of 420% from pre-cART levels (6.8 per 100 person-years). Older age [relative risk (RR) 1.41 per 10 years older; P 5 0.005], female gender (RR 2.25 vs. male; P 5 0.003) and current exposure to didanosine (ddI), tenofovir and protease inhibitors were the major determinants. ConclusionsWe observed a relatively high rate of mild renal dysfunction in the absence of ART. In addition to traditional risk factors such as older age and diabetes/hypertension, female gender and current use of ddI, tenofovir and protease inhibitors were associated with a greater risk of decreased renal function as measured by eGFR.Keywords: antiretroviral exposure, estimated glomerular filtration rate (eGFR), renal impairment [7][8][9][10][11], there are a number of other factors potentially influencing the onset of renal disorders through different mechanisms, whose prevalence may be different in an HIV-positive population compared with the general population. Indeed, patients' longer survival following the introduction of cART may be considered as an additional risk for renal dysfunction, as long-term toxic events associated with the prolonged used of ART have been observed (e.g. metabolic alterations, diabetes, hypertension and cardiovascular events) [12][13][14]. It has been hypothesized that antiretroviral medications may have a direct effect in increasing the risk of renal dysfunction, and a variety of cART-related effects, including proteinuria, renal tubular damage, interstitial nephritis and overall declines in glomerular filtration rates, have been noted [15][16][17][18][19][20][21][22][23].The potential role of tenofovir in renal toxicity is a current clinical research question. As a consequence of its tolerability, convenient dosing and efficacy, this nucleoside reverse transcriptase inhibitor (NRTI) has been widely used as a component of cART regimens. There are...

show abstract

“…7 This has caused the risk factors for CKD in HIV-infected persons to be a combination of traditional and HIV-related factors, including low CD4 counts, high viral load, intravenous drug use, hepatitis C virus (HCV) coinfection, and use of specific antiretroviral drugs. [8][9][10][11][12] Finally, as in the general population, albuminuria and decreased kidney function in HIV-positive individuals have been associated with worse outcomes such as a progression to AIDS and death. 13,14 The aim of our study was to assess the prevalence of CKD and to determine epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients.…”

Section: Introductionmentioning

confidence: 99%

“…associated with the development of CKD. [7][8][9][10][11] Age was a factor associated with CKD in our population. This finding is similar to those reported by other studies, being that the relative risk increase for CKD (defined as eGFR or albuminuria) for every 10 years of age is from 1.5 to 5.5.…”

mentioning

confidence: 99%

Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients

et al. 2019

View full text Add to dashboard Cite

Fatores epidemiológicos, clínicos e laboratoriais associados à doença renal crônica em pacientes mexicanos infectados pelo HIV Objetivo: Determinar a prevalência de doença renal crônica (DRC) e os fatores epidemiológicos, clínicos e laboratoriais associados à DRC em pacientes mexicanos infectados pelo HIV. Métodos: Estudo transversal. Incluímos 274 pacientes com HIV/AIDS. A DRC foi definida pela taxa de filtração glomerular estimada (TFGe < 60 mL/min/1,73 m 2 , avaliada pelo CKD-EPI) e pelos critérios de albuminúria das diretrizes do KDIGO. As características clínicas, epidemiológicas e laboratoriais foram comparadas entre pacientes com e sem DRC. Os fatores associados à DRC foram avaliados por análise de regressão logística. Resultados: A média da idade foi de 41 ± 11 anos e 72,3% dos pacientes eram homens. A prevalência global de DRC foi de 11,7% (n = 32); 7,2% (n = 20) foram definidos pelo critério TFGe; 7,6% (n = 21), pelo critério da albuminú-ria; e 3,2% (n = 9), pelos dois critérios para DRC. Os estágios mais frequentemente observados da DRC foram o estágio KDIGO G3A1 com 4,7% (n = 13); estágio KDIGO G1A2 com 3,6% (n = 10) e estágio KDIGO G3A2 com 1,7% (n = 5). Os fatores associados à DRC foram o uso de abacavir/lamivudina (OR 3,2; IC95% 1,1-8,9; p = 0,03), contagem de linfócitos CD4 < 400 células/ μL (OR 2,6; 95% 1,03-6,4, p = 0,04), idade (OR 1,1; IC95% 1,04-1,2, p = 0,001) e albuminúria (OR 19,98; IC95%: 5,5-72,2; p < 0,001). Conclusões: A DRC foi uma complicação frequente em pacientes infectados pelo HIV. Esses achados confirmam a importância do rastreamento e da detecção precoce da DRC, bem como a importância de identificar e tratar os fatores de risco tradicionais e não tradicionais associados à DRC. ResumoPalavras-chave: Insuficiência Renal Crôni-ca; HIV; Insuficiência Renal. Aim:To determine the prevalence of chronic kidney disease (CKD) and the epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients. Methods: Crosssectional study. We included 274 patients with HIV/AIDS. CKD was defined by the estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m 2 assessed by CKD-EPI) and albuminuria criteria from KDIGO guidelines. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without CKD. The factors associated with CKD were assessed by logistic regression analysis. Results: The mean age was 41±11 years, and 72.3% of the patients were men. The global prevalence of CKD was 11.7% (n = 32); 7.2% (n = 20) were defined by eGFR criterion; 7.6% (n = 21), by the albuminuria criterion; and 3.2% (n = 9), by both CKD criteria. The most frequently observed stages of CKD were KDIGO G3A1 stage with 4.7% (n = 13), KDIGO G1A2 stage with 3.6% (n = 10) and KDIGO G3A2 stage with 1.7% (n = 5). The factors associated with CKD were use of abacavir/lamivudine (OR 3.2; 95% CI 1.1-8.9; p = 0.03), a CD4 lymphocyte count < 400 cells/μL (OR 2.6; 95% 1.03-6.4, p = 0.04), age (OR 1.1; 95% CI 1.04-1.2, p = 0.001) and albuminuria (OR 19.98...

show abstract

Chronic Kidney Disease Incidence, and Progression to End‐Stage Renal Disease, in HIV‐Infected Individuals: A Tale of Two Races

Abstract: The results of this study suggest that African American-white disparities in HIV-related ESRD are explained predominantly by a more aggressive natural disease history in African Americans and less by racial differences in CKD incidence.

Cited by 192 publications

References 29 publications

Close Monitoring of eGFR Should Be Performed in HIV-Infected Patients Aged over 37 Years

Close Monitoring of eGFR Should Be Performed in HIV-Infected Patients Aged over 37 Years

Evaluation of glomerular filtration rate in HIV-1-infected patients before and after combined antiretroviral therapy exposure*

Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients

Contact Info

Product

Resources

About