Clinical epidemiology of HIV-associated end-stage renal failure in the UK

Bansi, Loveleen; Hughes, Amelia; Bhagani, Sanjay; Mackie, Nicola; Leen, Clifford; Levy, Jeremy; Edwards, Simon; Connolly, John; Holt, Stephen G; Hendry, Bruce M.; Sabin, Caroline; Post, Frank A.

doi:10.1097/qad.0b013e3283320e12

Cited by 49 publications

(55 citation statements)

References 14 publications

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“…It is well established that HAART lowers the incidence of HIVAN and thus ESRD in Black patients [16,18,19,34] but it is unclear whether this is true in Caucasian patients [25][26][27]. In our study, the proportion of Caucasian patients with ESRD was higher than in most studies (74.4%) [16,22,24,[26][27][28].…”

Section: Discussioncontrasting

confidence: 55%

“…Thus, effective antiretroviral treatment became easier and safer for patients with renal impairment only very recently. The survival time of patients with ESRD was longer in our study compared with other studies, but lower rates of IDU (33.3% vs. 50 -65%, respectively) and HCV coinfection (38.5% vs. 67-68%, respectively) are the most likely explanations for this difference [19,21,22,28].It is well established that HAART lowers the incidence of HIVAN and thus ESRD in Black patients [16,18,19,34] but it is unclear whether this is true in Caucasian patients [25][26][27]. In our study, the proportion of Caucasian patients with ESRD was higher than in most studies (74.4%) [16,22,24,[26][27][28].…”

contrasting

confidence: 50%

“…The epidemiology of ESRD outside the USA has not been extensively studied [24][25][26][27] but could provide new insights, as most US cohorts consist of a high proportion of Black patients with coeval injecting drug use (IVDU). Conversely, European cohorts consist of mostly Caucasian HIVinfected patients with various proportions of IDU and far fewer Black patients with almost no IDU [19,26,28].…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, European cohorts consist of mostly Caucasian HIVinfected patients with various proportions of IDU and far fewer Black patients with almost no IDU [19,26,28].…”

Section: Introductionmentioning

confidence: 99%

“…Earlier studies, mainly from the USA, concluded that, almost exclusively in Black patients, HIVAN is one of the major causes of ESRD [6,21,22], but histological confirmation of HIVAN is infrequent and the diagnosis is usually made clinically. More recent studies have reported an increasing relevance of traditional risk factors as well as chronic hepatitis C virus (HCV) coinfection in the development of ESRD in HIVinfected patients [7,23].The epidemiology of ESRD outside the USA has not been extensively studied [24][25][26][27] but could provide new insights, as most US cohorts consist of a high proportion of Black patients with coeval injecting drug use (IVDU). Conversely, European cohorts consist of mostly Caucasian HIVinfected patients with various proportions of IDU and far fewer Black patients with almost no IDU [19,26,28].…”

mentioning

confidence: 99%

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End‐stage renal disease and dialysis in HIV‐positive patients: observations from a long‐term cohort study with a follow‐up of 22 years

et al. 2012

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ObjectivesRenal disease is a common and serious complication in HIV-infected patients. MethodsA retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease (ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy (HAART)], 1997 (early HAART) and 2004. ResultsData for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years (PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk (RR) 5.1; 95% confidence interval (CI) 2.3-10.3; P < 0.0001], injecting drug use (IDU) (RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus (HCV) coinfection (RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up (PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 (RR 0.72; P = 0.52), but significantly from period 1 to 3 (RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality (RR 9.9; 95% CI 6.3-14.5; P < 0.0001). ConclusionAs a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD.Keywords: chronic kidney disease, haemodialysis, HIV-associated nephropathy, renal failure, renal replacement therapy Accepted 18 July 2012 IntroductionThe prevention and treatment of cardiovascular, liver and kidney diseases have increasingly been the focus of attention in attempts to reduce the morbidity and mortality of HIV-infected individuals [1]. In the USA, HIV-associated ESRD has become epidemic among Black patients [11,12]. Black individuals are more prone to kidney disease than any other ethnic group in the general [13,14] and HIV-infected populations, possibly as a consequence of predisposing genetic polymorphisms [15]. The risk of ESRD in Black HIV-infected individuals has been reported to be three-to six-fold higher than in Caucasian HIV-infected patients [7,16,17], reflecting the susceptibility of Black patients to develop HIVAN. The introduction of highly active antiretroviral therapy (HAART) has reduced the incidence of HIVAN and ESRD among Black patients [18][19][20], but the prevalence of ESRD is projected to further increase [11,12]. Earlier studies, mainly from the USA, concluded that, almost exclusively in Black patients, HIVAN is one of the major causes of ESRD [6,21,22], but histologica...

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Section: Discussioncontrasting

confidence: 55%

contrasting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

“…Conversely, European cohorts consist of mostly Caucasian HIVinfected patients with various proportions of IDU and far fewer Black patients with almost no IDU [19,26,28].…”

Section: Introductionmentioning

confidence: 99%