Spectrum of chronic kidney disease in HIV‐infected patients

Abstract

The aim of the study was to investigate the prevalence and aetiology of chronic kidney disease (CKD) and trends in estimated glomerular filtration rate (eGFR) in HIV-infected patients. MethodsAscertainment and review of CKD cases among patients attending King's College and Brighton Hospitals, UK were carried out. CKD was defined as eGFR o60 mL/min for ! 3 months. Longitudinal eGFR slopes were produced to examine trends in renal function before, during and after exposure to indinavir (IDV) or tenofovir (TFV). ResultsCKD prevalence was 2.4%. While HIV-associated nephropathy accounted for 62% of CKD in black patients, 95% of CKD in white/other patients was associated with diabetes mellitus, hypertension, atherosclerosis and/or drug toxicity. Exposure to IDV or TFV was associated with an accelerated decline in renal function (4.6-fold and 3.7-fold, respectively) in patients with CKD. In patients initiating IDV, age ! 50 years increased the odds of CKD [odds ratio (OR) 4.9], while in patients initiating TFV, age ! 50 years (OR 5.4) and eGFR 60-75 mL/min (OR 17.2) were associated with developing CKD. ConclusionThis study highlights the importance of metabolic and vascular disease to the burden of CKD in an ageing HIV-infected cohort. In patients who developed CKD, treatment with IDV or TFV was associated with an accelerated decline in renal function.Keywords: glomerular filtration rate, HIV, indinavir, kidney, tenofovir Accepted 20 November 2008 Introduction Acute renal failure (ARF) and chronic kidney disease (CKD) are important complications of HIV infection [1]. Approximately 6% of HIV-infected patients develop one or multiple episodes of ARF [2], and 15% of patients have evidence of CKD [3,4]. ARF usually occurs in the setting of severe (opportunistic) infections, malignancy or liver disease [2,5], and both ARF and CKD are associated with advanced immunodeficiency [2][3][4][5][6]. Black HIV-infected patients are at risk of developing HIV-associated nephropathy (HIVAN), which is characterized by heavy proteinuria and rapid progression to end-stage renal disease (ESRD) [7][8][9]. HIVAN, idiopathic noncollapsing focal and segmental glomerulonephritis (FSGS), immune complex kidney disease and other glomerulopathies predominate in biopsy series and among black patients with ESRD [7,[10][11][12][13].In the general, HIV-uninfected population, the prevalence of CKD increases dramatically in those aged 50 years and over [14]. CKD in these patients is associated with diabetes mellitus, hypertension and atherosclerosis [15], and is an independent risk factor for coronary heart disease [16]. CKD in this setting is often insidious in onset and may take decades to become clinically manifest. The objectives of this study were to describe the prevalence and aetiology of CKD in HIV-infected patients receiving care in the UK, and to examine trends in renal function before, during and after exposure to IDV or TFV in patients with CKD. Methods Case ascertainmentAll HIV-infected adults with CKD who attended King's College Hospital ...

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

“…Many studies have investigated predictive factors of GFR changes (21)(22)(23), whereas fewer studies have been conducted on large data sets investigating factors associated with CKD (5,24,25). To our knowledge, our study is the largest cohort of HIV-infected adults investigating risk factors of CKD, especially the effect of each ARV drug.…”

Kidney failure during HIV disease treated with tenofovir, multiple concurrent diseases and drug therapies

“…However, an increasingly modified disease presentation, which may lead to a true "pathomorphism" of infectious, neoplastic, and other HIV-related and AIDS-related and unrelated disorders in an increasing number of cases, has been recognized just since the cART era. As known, this relevant phenomenon has emerged in parallel with the use of effective and potent cART regimens, and it may be attributable to a very extensive number and variety of concurrent, and not always independent factors and co-factors [8,[12][13][14][15][16][17][18][19][20], including immune recovery achieved just thanks to cART itself [21,22], and worldwide epidemiological changes (due to huge immigration flows, for example) [23]. At the same time, the number of "AIDS presenters", i.e.…”

Polyploidy and Mitotic Cell Death Are Two Distinct HIV-1 Vpr-Driven Outcomes in Renal Tubule Epithelial Cells

“…Additionally, HIV+ patients remain at an increased risk for developing ESRD, particularly if they are of African descent [18]. Several factors have been linked to HIV---associated CKD, including race, HCV co---infection, comorbid diabetes, protracted use of cART and age [14,15]. Prolonged cART induced nephrotoxicity, primarily caused by protease inhibitors and tenofovir therapy, is becoming an increasing clinical burden in aging HIV individuals [19,20].…”