Prevalence of Chronic Kidney Disease Among HIV-infected Individuals in Japan

Muramatsu, Takashi; Yanagisawa, Naoki; Chikasawa, Yushi; Seita, Ikuo; Yotsumoto, Mihoko; Otaki, Manabu; Ogata, Kyoichi; Hagiwara, Takeshi; Suzuki, Takashi; Suganuma, Akihiko; Imamura, Akifumi; Amano, Kagehiro; Yamamoto, Yasuyuki; Nitta, Kosaku; Ajisawa, Atsushi; Fukutake, Katsuyuki; Ando, Minoru

doi:10.11150/kansenshogakuzasshi.87.14

Cited by 5 publications

(4 citation statements)

References 39 publications

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“…MDRD, CG and CKD-EPI equations were used to estimate GFR in 45 studies (n = 167,011 participants), 19 studies (n = 59,414 participants) and 14 studies (n = 41,791 participants) respectively. Thirty-one studies (n = 111,415 participants) used MDRD [ 32 – 35 , 37 – 45 , 48 , 51 – 54 , 57 , 59 , 62 , 65 – 69 , 82 , 84 , 85 , 89 ] equation only; 7 (n = 16,756 participants) used CKD–EPI [ 76 – 80 , 83 , 86 ] and 9 (n = 24,622 participants) used CG only [ 23 , 70 – 75 , 81 ]. Seven articles (n = 31,268 participants) applied MDRD and CG [ 36 , 50 , 55 , 56 , 60 , 64 , 87 ]; 4 (n = 20,742 participants) applied MDRD and CKD-EPI [ 46 , 47 , 49 , 58 ] while 3 (n = 4,275 participants) applied all 3 equations [ 61 , 63 , 88 ].…”

Section: Resultsmentioning

confidence: 99%

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis

et al. 2018

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IntroductionThe widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients.MethodsWe searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman–Tukey transformation.ResultSixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2–7.7%) with MDRD, 4.8% (95%CI 2.9–7.1%) with CKD-EPI and 12.3% (95%CI 8.4–16.7%) with Cockcroft–Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2–11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9–20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0–3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status.ConclusionCKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.

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Section: Resultsmentioning

confidence: 99%

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis

et al. 2018

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“…In a study in China, 16.8% of HIV-infected patients had chronic renal insufficiency (defined as eGFR <60 mL/min/1.73 m 2 and/or proteinuria), but this study reported a prevalence of just decreased eGFR (<60 mL/min/1.73 m 2 ) of 5.6% [ 25 ]. In addition, studies in Japan have reported renal insufficiency (defined as eGFR <60 mL/min/1.73 m 2 ) prevalence rates from 6.7% to 9.7% [ 33 34 ]. In a Korean chronic kidney disease (CKD) cohort study, using just decreased eGFR (<60 mL/min/1.73 m 2 ) as a criterion, the prevalence was 5.0% [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Risk Factors of Renal Insufficiency among Korean HIV-Infected Patients: The Korea HIV/AIDS Cohort Study

et al. 2017

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BackgroundRenal disease is one of the leading causes of morbidity and mortality among people infected with human immunodeficiency virus (HIV). However, there are very few published studies about renal insufficiency in HIV-infected persons in Asia, especially in South Korea.Materials and MethodsA cross-sectional study was performed to investigate the prevalence and risk factors of renal insufficiency, defined as <60 mL/min/1.73 m2, in subjects in the Korea HIV/AIDS Cohort Study enrolled from 19 institutions between December 2006 and July 2013. Data at entry into the cohort were analyzed.ResultsOf 454 enrolled subjects, 24 (5.3%) showed renal insufficiency at entry into the cohort. The mean age of patients in the renal insufficiency group was 5.28 years and the majority were male subjects (91.7%). All the patients were receiving antiretroviral agents, mostly protease inhibitor-based regimens (76.4%), for an average of 19 months. In univariate analysis, older age (P = 0.002), diabetes mellitus (DM) (P = 0.0002), unknown route of transmission (P = 0.007), and taking indinavir (P = 0.0022) were associated with renal insufficiency. In multivariable analysis, older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.03–1.12, P = 0.002], DM [OR 3.03, 95% CI 1.17–7.82, P = 0.022], unknown route of transmission [OR 6.15, 95% CI 1.77–21.33, P = 0.004], and taking indinavir [OR 3.07, 95% CI 1.17–8.05, P = 0.023] were independent risk factors of renal insufficiency.ConclusionThe prevalence of renal insufficiency in HIV-infected subjects in this study was relatively low, similar to that in other countries. Aging, DM, and taking indinavir were significantly associated with decreased glomerular filtration rate. Furthermore, unknown route of transmission was an independent risk factor, which was interpreted as a reflection of patient compliance. Further studies on the incidence and risk factors of renal insufficiency during HIV infection using follow-up cohort data are necessary.

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“…Patients with HIV have a higher incidence and increasing prevalence of CKD than HIV-negative patients [12]. The prevalence of CKD in HIV-infected patients in Japan was 15.4% among 732 patients, and 9.7% had grade 3 CKD or higher [13].…”

Section: Hiv Complication Screening and Treatmentmentioning

confidence: 99%

Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report

et al. 2022

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Background Antiretroviral therapy (ART) has reduced mortality caused by AIDS resulting from HIV infection. Meanwhile, the prevalence of chronic kidney disease, a chronic HIV complication, is increasing. Antiretroviral therapy has improved the life expectancy of HIV-infected kidney transplant recipients. In Japan, discrimination and prejudice against HIV persist, and few kidney transplants are performed. We report three cases in which kidney transplantation was smoothly performed with multidisciplinary collaboration. Case presentation The first case involved a 29-year-old male urgently hospitalized due to severe kidney dysfunction, diagnosed with HIV-associated nephropathy (HIVAN), and placed on maintenance dialysis. The patient was administered oral lamivudine, abacavir, and raltegravir as ART and underwent blood group-matched living donor kidney transplantation at age 32. The second case involved a 49-year-old male diagnosed as HIV-positive at age 33 and placed on maintenance dialysis for HIVAN at age 47. Darunavir, ritonavir, and dolutegravir (DTG) were initially administered. However, the ART was switched to rilpivirine (RPV) and DTG prior to kidney transplantation because of potential ART interactions with calcineurin inhibitors. The patient underwent blood group-matched living donor kidney transplantation. The third case involved a 41-year-old male diagnosed as HIV-positive at 23 years old and treated with RPV and DTG. Due to autosomal dominant polycystic kidney disease (ADPKD), his kidney function gradually worsened, and he was started on hemodialysis. He underwent hemodialysis, followed by blood type-matched living donor kidney transplantation. In all cases, transplant physicians, nephrologists, infectious disease physicians, hepatologists, nurses, pharmacists, nutritionists, and clinical psychologists collaborated to discuss and share medical problems and sociopsychological backgrounds of the patients. There was no rejection, CD4+ lymphocyte counts were maintained, and there was no increase in viral load post-surgery. Information sharing among various departments has continued post-surgery, kidney function has improved, and no increase in viral load has been identified on follow-up. Conclusions Kidney transplantation is the kidney replacement therapy of choice for HIV-infected patients with CKD. Specialized support is required for kidney transplantation, including coordinating immunosuppressive therapy to avoid rejection, learning about drug interactions, and providing sociopsychological support. Multidisciplinary collaboration is important to ensure safe and smooth kidney transplantation care for HIV-infected patients.

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Prevalence of Chronic Kidney Disease Among HIV-infected Individuals in Japan

Cited by 5 publications

References 39 publications

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis

The Prevalence and Risk Factors of Renal Insufficiency among Korean HIV-Infected Patients: The Korea HIV/AIDS Cohort Study

Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report

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