Baseline Kidney Function as Predictor of Mortality and Kidney Disease Progression in HIV-Positive Patients

Abstract

BackgroundChronic kidney disease (CKD) is associated with increased all-cause mortality and kidney disease progression. Decreased kidney function at baseline may identify human immunodeficiency virus (HIV)-positive patients at increased risk of death and kidney disease progression.Study DesignObservational cohort study.Setting & Participants7 large HIV cohorts in the United Kingdom with kidney function data available for 20,132 patients.PredictorBaseline estimated glomerular filtration rate (eGFR).OutcomesDeath and progression to stages 4-5 CKD (eGFR <30 mL/min/1.73 m2 for >3 months) in Cox proportional hazards and competing-risk regression models.ResultsMedian age at baseline was 34 (25th-75th percentile, 30-40) years, median CD4 cell count was 350 (25th-75th percentile, 208-520) cells/μL, and median eGFR was 100 (25th-75th percentile, 87-112) mL/min/1.73 m2. Patients were followed up for a median of 5.3 (25th-75th percentile, 2.0-8.9) years, during which 1,820 died and 56 progressed to stages 4-5 CKD. A U-shaped relationship between baseline eGFR and mortality was observed. After adjustment for potential confounders, eGFRs <45 and >105 mL/min/1.73 m2 remained associated significantly with increased risk of death. Baseline eGFR <90 mL/min/1.73 m2 was associated with increased risk of kidney disease progression, with the highest incidence rates of stages 4-5 CKD (>3 events/100 person-years) observed in black patients with eGFR of 30-59 mL/min/1.73 m2 and those of white/other ethnicity with eGFR of 30-44 mL/min/1.73 m2.LimitationsThe relatively small numbers of patients with decreased eGFR at baseline and low rates of progression to stages 4-5 CKD and lack of data for diabetes, hypertension, and proteinuria.ConclusionsAlthough stages 4-5 CKD were uncommon in this cohort, baseline eGFR allowed the identification of patients at increased risk of death and at greatest risk of kidney disease progression.

Prevalence of anemia in renal insufficiency among HIV infected patients initiating ART at a hospital in Northeast Ethiopia

“…As decreased renal function at baseline may identify HIV infected patients at increased risk of mortality and kidney disease progression [28], regular screening of these population for renal impairment at base line should be critical not only to reduce mortality but also to improve patient outcomes. One of the many known complications of decreased renal function is anemia, a condition in which the number of circulating red blood cells, and therefore the level of hemoglobin, is lower than normal.…”

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

“…A low baseline eGFR at the beginning of HAART may lead to both acute kidney injury and chronic kidney disease during the treatment [27,28]. Baseline renal function allowed the identification of HIV-infected patients with increased risk of progression to renal disease in a study conducted in the UK, in which baseline eGFR \ 90 ml/ min/1.73 m 2 was an associated risk factor [29]. Other studies have shown that starting HAART in patients with baseline eGFR \ 90 ml/min/1.73 m 2 was associated with an increased risk of mortality, especially for those with eGFR \ 30 ml/min/1.73 m 2 [30,31].…”

“…A univariate analysis and binary logistic regression was carried out in order to identify risk factors associated with renal toxicity by using the forward stepwise method (likelihood ratio) Main outcome measure: Incidence rate for moderate and severe renal insufficiency (RI) Results 451 patients were included in the study. The incidence rate of moderate RI was 29 …”

Switching antiretroviral regimes for the treatment of HIV: safety implications

“…Renal disease is an important contributor to morbidity and mortality in HIV-infected patients [50,51]. TDF is associated with excellent virological suppression, but some patients develop clinically relevant nephrotoxicity over time, especially individuals with risk factors for renal disease [9].…”