Incidence and Predictors of Acute Kidney Injury in an Urban Cohort of Subjects with HIV and Hepatitis C Virus Coinfection

Abstract

Coinfection with hepatitis C (HCV) significantly increases the risk of acute and chronic renal disease in HIVinfected individuals. However, the burden of acute kidney injury (AKI) directly attributable to HIV among HCV-infected individuals and associated risk factors are not well understood. Within a prospective cohort, AKI episodes were identified by a rise in creatinine of 0.5 mg/dL. Incidence of first AKI events was calculated for HIV/HCV coinfected versus HCV monoinfected subjects, and multivariable analyses using Cox proportional hazards were performed to identify predictors of AKI. Throughout the study period, 35% HIV/HCV coinfected and 17% HCV monoinfected subjects developed AKI, with incidence of 8. (HR 2.06 [1.15, 3.71]) were independently associated with AKI. HCV genotype, HCV viral load, hazardous drinking, and heroin use were not associated with AKI. Study limitations included potential misclassification bias of HCV-infected individuals as serial HIV antibody testing was not routinely performed after study entry, and inability to adjust for tenofovir use in multivariable analysis. In conclusion, among subjects with HCV infection, decompensated cirrhosis, HIV coinfection, and cocaine use are associated with increased risk of AKI. These findings highlight the importance of preventing and treating cirrhosis, controlling HIV coinfection, and reducing cocaine use in HIV/HCV coinfected persons.

Hepatitis C Virus Infection Increases the Risk of Developing Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…HCV coinfection resulted a risk factor for increased healthcare resource utilization in HIV-infected persons in the USA; multivariable Poisson model showed that HCV coinfection was associated with higher rate of emergency department visits, aRR 2.07 (95 % CI 1.49; 2.89), P \ 0.001. In addition to liver damage, renal disease (17.7 vs. 12 %, P \ 0.014) played a larger role [46]. Chronic kidney disease is an important public health problem which significantly increases the likelihood of adverse outcomes and high healthcare costs; in addition to the conventional risk factors for chronic kidney disease in the general population, HCV may be an additional factor.…”

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls

“…Almost 2% of people with HIV are estimated to develop kidney failure, and liver failure is an important non-AIDS cause of death [1–4]. In the Solid Organ Transplantation in HIV: Multi-Site Study (HIV-TR), we hypothesized that immunosuppression would not accelerate HIV disease progression nor reduce survival in recipients with a relatively intact immune system and well suppressed viremia, and that outcomes would be similar to other commonly accepted higher-risk transplant patients, such as those over the age of 65 [5–7].…”

Clinical profile and treatment outcome of acute kidney injury (AKI) in a tertiary care hospital

“…There are many more studies which supports the role of drug induced nephropathy and AKI. [18][19][20] Timely diagnosis and management of this disease condition confer a favourable prognosis to the patient. The progression of AKI lead to increased hospital mortality rates and increased length of stays that might prove a wastage of limited resources in a setting like India.…”