Clinical Characteristics of Kidney Disease in Japanese HIV-Infected Patients

Abstract

Background: Kidney disease has become an important cause of morbidity and mortality in HIV-infected patients in Western countries. Japan is a country with an increasing number of newly infected HIV patients. However, only a few studies have investigated kidney disease in Asian populations infected with HIV. Methods: We studied the prevalence of kidney disease by reviewing the clinical data of 732 HIV-infected Japanese patients. Risk factors for proteinuria, albuminuria, and renal dysfunction were determined using multivariate logistic regression analysis. Results: Microalbuminuria, macroalbuminuria and proteinuria were present in 13.2, 4.55 and 9.52% of patients, respectively. The prevalence of chronic kidney disease of any stage and CKD ≧ stage 3 was 15.4 and 9.70%, respectively. Multivariate analysis showed significant associations between increasing levels of serum creatinine and cholesterol, and the coexistence of diabetes, hypertension and hepatitis C coinfection with either proteinuria or albuminuria, which was significantly related to the presence of renal dysfunction. Lower CD4 cell count was associated with the presence of renal dysfunction, but higher HIV-RNA level was not. Conclusions: Our study has shown the international dimension of the burden of kidney disease in HIV-infected patients. Either proteinuria or albuminuria is likely the most significant factor for renal dysfunction in these patients.

Characteristics and Associations of Renal Dysfunction at Presentation in Haart-Naïve HIV-Infected Subjects in Port Harcourt, Nigeria

“…This is relatively higher than the 3.5% -9.7% proportion of individuals with diminished renal function as reported in Asian and European HIV-infected populations (2,15,16) . However, this finding was consistent with the findings of Lucas et al, which reported a 6-fold GFR decrease in HIV-infected blacks, compared to HIV-infected whites (17) .…”

“…It has also been previously reported, that about 91% of HIVinfected persons receiving dialysis in the United States were blacks (1,15) . Individuals of African descent have been considered to have a higher risk of HIV-associated nephropathy due to their peculiar predilection to podocyte proliferation and tubular dilatation with atrophy and flattening of the tubular cells (15)(16)(17) . In the pre-HAART era, HIVAN with its dramatic clinical features, was so frequent that it became almost synonymous with HIV-associated chronic kidney disease especially in black person between 20 -64 years of age (2,18) .…”

How to manage HIV-infected patients with chronic kidney disease in the HAART era

“…While 7.2-32.6% of HIV-infected individuals have proteinuria, which is mostly diagnosed based on urine dipstick examination [7,9,10,[24][25][26][27][28], 8.7-17.8% of these individuals have albuminuria, which is mostly defined according to the urinary albumin to creatinine ratio (ACR) [10,29,30]. The prevalence of renal dysfunction, defined as a sustained decrease in the estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m 2 for 3 months or more, varies from 3.5% to 9.7% depending on the social and demographic characteristics of the HIV population that is being studied [9][10][11][12]28]. When the presence of proteinuria and reduced eGFR are combined, the prevalence of CKD stages 1-5 ranges from 15.4% to 23.7% [2,9,10,12,28].…”

“…Now, nephrologists are faced with several challenges regarding kidney disease in HIV-infected population including means of raising awareness of the problem of undiagnosed kidney disease, identifying early signs of kidney disease, and working in collaboration with HIV experts to provide the best treatment for patients with renal impairment. The prevalence of CKD is increasing among Asian HIV populations [9,10] as well as HIV populations in Western countries [11,12]. In general, since early identification of CKD provides an opportunity to implement strategies known to inhibit the progressive loss of kidney function [13][14][15], early identification of HIV-infected individuals at risk for developing CKD could be important as the initial step in modifying the progression of CKD [16][17][18].…”

HIV-Infected Men with an Elevated Level of Serum Cystatin C have a High Likelihood of Developing Cancers

“…HIV-RNA level was measured using the Roche Amplicor HIV Monitor assay based on reverse transcription-polymerase chain reaction (Roche Molecular Systems, Tokyo, Japan; lower detection limit, 50 copies/mL). Other laboratory variables were measured using standard methods as described previously [21].…”