Determinants of incident chronic kidney disease and progression in a cohort of HIV‐infected persons with unrestricted access to health care

Abstract

ObjectivesAs socioeconomic factors may impact the risk of chronic kidney disease (CKD), we evaluated the incidence and risk factors of incident CKD among an HIV-infected cohort with universal access to health care and minimal injecting drug use (IDU). MethodsIncident CKD was defined as an estimated glomerular filteration rate (eGFR) <60 ml/min/1.73 m 2 for Ն 90 days. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Rates were calculated per 1000 person-years (PY). Associations with outcomes were assessed using two separate Cox proportional hazard models, adjusting for baseline and time-updated covariates. . Baseline factors associated with CKD included older age, lower CD4 count at HIV diagnosis [compared with CD4 count Ն 500 cells/mL, hazard ratio (HR) 2.1 (95% CI 1.2-3.8) for CD4 count 350-499 cells/mL; HR 3.6 (95% CI 2.0-6.3) for CD4 count 201-349 cells/mL; HR 4.3 (95% CI 2.0-9.4) for CD4 count Յ 200 cells/mL], and HIV diagnosis in the pre-highly active antiretroviral therapy (HAART) era. In the time-updated model, low nadir CD4 counts, diabetes, hepatitis B, hypertension and less HAART use were also associated with CKD. AA ethnicity was not associated with incident CKD in either model. Results Among ConclusionsThe low incidence of CKD and the lack of association with ethnicity observed in this study may in part be attributable to unique features of our cohort such as younger age, early HIV diagnosis, minimal IDU, and unrestricted access to care. Lower baseline CD4 counts were significantly associated with incident CKD, suggesting early HIV diagnosis and timely introduction of HAART may reduce the burden of CKD.

Kidney disease in antiretroviral‐naïve HIV‐positive adults with high CD4 counts: prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

“…The observed relationship was driven by a significant decrease in the odds of CKD in Hispanics, with no significant association observed between black race and CKD. Although black race is a strong predictor of advanced CKD and ESRD in HIVpositive adults, our results are consistent with prior studies demonstrating little or no association with earlier stages of CKD in HIV-positive black individuals [11,12]. Our findings are also consistent with observations in the general US population, where the low prevalence of early-stage CKD in African-Americans and Hispanics contrasts sharply with the disproportionate burden of ESRD in those populations [13].…”

Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis

“…Crane estimated the relative risk of 51 CKD stage 3 patients among 445 HIV-infected people who were aged 30-40 years, 40-50 years and over 50 years compared to people less than 30 years to be 0.90 (0.2-3.2), 2.10 (0.6-7.6) and 4.40 (1.4-6.8) respectively [4]. The other cohort studies [13,14,20] provided similar trends across age and CD4 counts. We found that the risk of renal disease among HIV-infected people was positively correlated with age (correlation, r = 0.71).…”

Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients

“…Ganesan et al [21] estimated an incidence rate for all cause moderate chronic RI in a HIV-infected cohort of five cases per 1000 person-year. However, kidney damage rarely occurred due to nephropathy induced by the virus itself but to other risk factors including the HAART.…”