Comorbid Diabetes and the Risk of Progressive Chronic Kidney Disease in HIV-Infected Adults

Abstract

Introduction Approximately 15% of HIV-infected individuals have comorbid diabetes. Studies suggest that HIV and diabetes have an additive effect on chronic kidney (CKD) progression; however, this observation may be confounded by differences in traditional CKD risk factors. Methods We studied a national cohort of HIV-infected and matched HIV-uninfected individuals who received care through the Veterans Healthcare Administration. Subjects were divided into four groups based on baseline HIV and diabetes status, and the rate of progression to an estimated glomerular filtration rate (eGFR) < 45ml/min/1.73m2 was compared using Cox-proportional hazards modeling to adjust for CKD risk factors. Results 31,072 veterans with baseline eGFR ≥ 45ml/min/1.73m2 (10,626 with HIV only, 5,088 with diabetes only, and 1,796 with both) were followed for a median of 5 years. Mean baseline eGFR was 94ml/min/1.73m2, and 7% progressed to an eGFR < 45ml/min/1.73m2. Compared to those without HIV or diabetes, the relative rate of progression was increased in individuals with diabetes only [adjusted hazard ratio (HR) 2.48; 95% confidence interval (CI) 2.19–2.80], HIV only [HR 2.80, 95% CI 2.50–3.15], and both HIV and diabetes [HR 4.47, 95% CI 3.87–5.17]. Discussion Compared to patients with only HIV or diabetes, patients with both diagnoses are at significantly increased risk of progressive CKD even after adjusting for traditional CKD risk factors. Future studies should evaluate the relative contribution of complex comorbidities and accompanying polypharmacy to the risk of CKD in HIV-infected individuals, and prospectively investigate the use of cART, glycemic control, and adjunctive therapy to delay CKD progression.

HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration among men with and without HIV infection

“…Two recent publications documented the association of diabetes and HIV on decreased renal function [41] and ESRD [42]. In these studies, the presence of either HIV or diabetes was associated with a higher risk of diminished GFR [41], and ESRD among African Americans [42]; a relationship which was similar to the increased odds of hyperfiltration in our study.…”

“…In these studies, the presence of either HIV or diabetes was associated with a higher risk of diminished GFR [41], and ESRD among African Americans [42]; a relationship which was similar to the increased odds of hyperfiltration in our study. In contrast to our findings, however, those who had both diabetes and HIV were at even greater risk of incidence of low eGFR <45 ml/min compared to those with HIV or diabetes only [41]. Similar to the results for ESRD [42], we did not find an additive effect of HIV and diabetes on hyperfiltration.…”

Polymorphisms in the Non-Muscle Myosin Heavy Chain Gene (MYH9) Are Associated with Lower Glomerular Filtration Rate in Mixed Ancestry Diabetic Subjects from South Africa

“…An epidemic of diabetes in South Africa is magnified by the HIV/AIDS epidemic where the largest HIV infected population in the world resides [32], [33], [34], [35], [36]. Individuals with both HIV and diabetes are reported to be at significantly increased risk of progressive CKD compared with patients with only one commodity [37]. Furthermore, HIV associated nephropathy is strongly linked to MYH9 polymorphism in African Americans [38].…”

Diabetes Mellitus Type 2 and Abnormal Glucose Metabolism in the Setting of Human Immunodeficiency Virus

“…al. (26) measured progression to GFR < 45 mL/min/1.73m 2 using data from the large Veterans Aging Cohort Study. The presence of both HIV and DM was associated with a hazard ratio of 4.47 (95% CI: 3.87–5.17) for development of CKD.…”