Monitoring of kidney function in HIV‐positive patients

Abstract

HIV-positive patients are at increased risk of developing chronic kidney disease. Although guidelines recommend regular monitoring of renal function in individuals living with HIV, the optimal frequency remains to be defined. In this review, we discuss the renal syndromes that may be identified at an earlier stage via routine assessment of kidney function, and provide guidance in terms of the frequency of monitoring, the most useful tests to perform, and their clinical significance. Specifically, we address whether annual monitoring of kidney function is appropriate for the majority of HIV-positive patients.

Monitoring of kidney function in older people living with HIV

“…Consequently, many older patients with HIV infection may benefit from more frequent monitoring of renal function. We agree with Musso and Belloso that annual monitoring of renal function is probably sufficient for elderly patients with eGFR ≥45 mL/min/1.73 m 2 who have stable renal function, normal urinalysis and an expected eGFR < 60 mL/min/ 1.73 m 2 based on Keller's equation (130 À age), provided that their antiretroviral regimens do not include tenofovir (TDF) and/or atazanavir [4]. We also concur that older patients with stable eGFR and moderate proteinuria (protein:creatinine ratio 50À100 mg/mmol) are likely to benefit from more frequent monitoring (i.e.…”

Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa

“…Monitoring of renal function in high‐burden settings is challenging . TDF continues to be widely used for first‐line ART in high‐burden regions, and in the absence of an affordable alternative, strategies to improve eGFR monitoring in individuals on TDF are needed Tenofovir alafenamide (TAF) is a tenofovir prodrug, with reported lower risk of renal toxicity .…”

“…However, TAF interacts with rifampicin, which is used for TB treatment, which makes the introduction of this drug in resource‐limited settings with a high burden of TB challenging . Management of renal function on ART is further challenged by limited access to laboratory services in resource‐limited settings, and further research to evaluate the potential of more accessible point‐of‐care technology for monitoring renal function is needed . In settings where relevant laboratory services are available, nonadherence to eGFR monitoring is widely reported .…”

Monitoring of kidney function in elderly HIV‐positive patients

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We would like to comment on the excellent review 'Monitoring of kidney function in HIV-positive patients' written by Yombi et al [1] and recently published in HIV Medicine. While we agree with their strategy for periodically evaluating renal function in individuals with HIV infection, we would like to propose a modification to this monitoring plan in order to make it more suitable for elderly people.

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“…Yombi et al [1] propose the criterion of a GFR higher or lower than 60 mL/min/1.73 m² for deciding the frequency of renal monitoring in this population. However, based on the above-mentioned nephrogeriatric evidence, we propose the following modification to their algorithm.…”