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

Abstract

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...

Factors associated to chronic kidney disease in people living with HIV/AIDS

“…While those who analyzed GFR<60 ml/min/1.73 m 2 and presence of proteinuria in more than one measure, in a recent study showed a global presence of 11.7% of CKD, with 7.6% being diagnosed only by the proteinuria criterion ( 38 ) . As well as what is represented in the Dutch (18.3%) ( 28 ) and Vietnamese cohorts (8.3%) ( 34 ) .…”

“…Among the non-modifiable associated factors for developing CKD, advanced age is considered an independent marker of decline in renal function in PLHIV by several scholars ( 18 , 27 - 28 , 38 - 39 ) . The same is also identified in this study, in which the cases have a mean age of 61.4 years old and, in the controls, 49.9 years old.…”

Nefrotoxicidade e alterações de exames laboratoriais por fármacos: revisão da literatura

“…Among the protease inhibitor antivirals, atazanavir has a cumulative nephrotoxic effect by an unknown mechanism 29 . Indinavir, on the other hand, has well-defined nephrotoxicity, with precipitation of indinavir sulphate crystals in the renal tubules and the development of acute interstitial nephritis 28 .…”

“…The drug is absorbed by the proximal tubular cells through an ion transport mechanism, however the percentage of tenofovir that is captured by the cells is greater than that excreted, resulting in its intracellular accumulation. This imbalance occurs due to changes in the expression of renal tubular transporters and mitochondrial metabolism 29,32 .…”

Prevalence and risk factors of chronic kidney disease in an HIV positive Mexican cohort

“…The global prevalence of CKD is 8-16%, while, in HIV subjects, the prevalence varies between geographic regions (in a range from 2 to 38%) [1]. A study in Northwest Mexico reported a prevalence of 11.7%, higher than the one reported in North America and Europe (4.7 and 9.7%, respectively) [3]. Thereby, the prevalence of CKD varies clearly across populations [4].…”