Acute kidney injury among HIV-infected patients admitted to the intensive care unit

Abstract

We describe the incidence, associations and outcomes of acute kidney injury (AKI) among HIV-infected patients admitted to the intensive care unit (ICU). We retrospectively analysed 223 admissions to an inner-London, University-affiliated ICU between 1999 and 2012, and identified those with AKI and performed multivariate analysis to determine associations with AKI. Of all admissions, 66% were affected by AKI of any severity and 35% developed stage 3 AKI. In multivariate analysis, AKI was associated with chronic kidney disease (odds ratio [OR] = 3.19; p = 0.014), a previous AIDS-defining illness (OR = 1.93; p = 0.039) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score, (OR = 3.49; p = 0.018, if > 30). No associations were demonstrated with use of anti-retroviral medication (including tenofovir), or an individual's HIV viral load or CD4 count. AKI was associated with higher inpatient mortality and longer duration of ICU admission. Among patients with stage 3 AKI, only 41% were alive 90 days after ICU admission. Among survivors, 74% regained good renal function, the remainder were dependent on renal replacement therapy or were left with significant ongoing renal dysfunction. Of note, many patients had baseline serum creatinine concentrations well below published reference ranges. AKI among HIV-infected patients admitted to ICU carries a poor prognosis.

Acute kidney injury in HIV‐infected patients: a critical review

“…However, in a study by Randall et al . , despite the association of previous AIDS‐defining conditions and AKI risk, it was found that CD4 count, HIV viral load and antiretroviral medication exposure were not associated with AKI risk.…”

“…The severity of acute illness as quantified by the SAPS II or APACHE II scores has also been associated with AKI in studies by Lopes et al and Randall et al [35,36]. The presence of sepsis is also a predictor of AKI in HIVinfected patients [25,26,29].…”

“…The reported incidence of AKI in HIV-infected patients is also variable depending on the setting. Although the majority of studies are retrospective, with different patient characteristics and follow-up times, the lowest incidence rate of AKI is reported in ambulatory patients, ranging from 5.7 to 9.4% [22][23][24] and up to 35% in developing countries [25], followed by hospitalized patients [8,[26][27][28][29][30][31][32][33][34] and the highest among critically ill patients, reaching up to 66% [35,36] (Table 2).…”

HIV and kidney diseases: 35 years of history and consequences

“…The highest AKI incidence, as expected, was observed in intensive care unit settings, ranging from 47 to 66%. The main risk factors were previous comorbidities such as CKD and illness severity [27, 28]. …”

“…In different settings nephrotoxicity accounted for up to 30% of AKI episodes [28]. Medications frequently used to treat HIV-related infections have been associated with AKI, such as aminoglycosides, pentamidine, amphotericin and trimethoprim/sulfamethoxazole, and antivirals such as acyclovir and foscarnet, among others.…”