Prevalence and Risk Factors Associated to Chronic Kidney Disease in HIV-Infected Patients on HAART and Undetectable Viral Load in Brazil

Abstract

BackgroundTo determine the prevalence and associated factors with chronic kidney disease (CKD) in a cohort of HIV-positive individuals with undetectable viral load on HAART.MethodsFrom March, 2009 to September 2009, 213 individuals between 18-70 years, period on HAART ≥12 months, viral load < 50 copies/mm3, and CD4 ≥ 200 cells/mm3, were consecutively enrolled at the outpatient clinic of Hospital de Clínicas, Porto Alegre, Brazil. Exclusion criteria were obesity, malnourishment, amputee, paraplegic, previous history of renal disease, pregnancy and hepatic insufficiency. Renal function was determined by estimated glomerular filtration rate (eGFR) assessed by the modification of diet in renal disease. CKD was defined as an eGFR less or equal than 60 ml/min/1.73 m2, for a period of at least 3 months. Poisson regression was used to determine factors associated with CKD.ResultsCKD was diagnosed in 8.4% of the population, and after adjustment, the risk factors were hypertension (RR = 3.88, 95%CI, 1.84 - 8.16), time on HAART (RR = 1.15, 95%CI,1.03–1.27) and tenofovir exposure (RR = 2.25, 95%CI, 1.04–4.95). Higher weight (RR = ,0.88 95%CI, 0.82–0.96) was associated to normal function.ConclusionsCKD was a common finding in this cohort of patients and was related to hypertension, time on HAART and tenofovir exposure. We suggest a more frequent monitoring of renal function, especially for those with risk factors to early identify renal impairment.

A Study of Renal Impairment in Hiv Seropositive Subjects Attending Art Clinic in K. R. Hospital, Mysore

“…Decline in renal function was significantly associated with less weight. This result is consistent with the study by Menezes et al 10 in Brazil, where higher weight was significantly associated with normal kidney function (RR = 0.89, p = 0.005). In the study by Struik et al 17 also lower weight was associated with lower eGFR.…”

“…Study by Keith Rawlings et al 15 in USA had a prevalence of 6%. A study by Menezes et al 10 in Brazil on HIV infected subjects with low viral load and CD4 count above 200 cells/mm 3 showed a prevalence of 8.4%.…”

“…10,11,12 It might also be affected by many opportunistic infections, duration of HAART, type of drug regimen as shown in many previous studies. 13,14 Most of the studies regarding renal impairment in HIV patients have been done outside India and data regarding prevalence and pattern of renal involvement and its correlation with various variables in this part of India is not available.…”

“…In the study conducted in Brazil by Menezes et al, 10 mean time on antiretroviral therapy was 7.8 (SD = 4.8) years and it was found that increased duration of therapy to be significantly associated risk factor for chronic kidney disease (Risk Ratio = 1.15, p-value = 0.011). In another followup study by Keith Rawlings et al 15 also showed increase in duration of ART was associated with progressive decline in estimated glomerular filtration rate.…”

HIV and kidney diseases: 35 years of history and consequences

“…Studies in Brazil have reported CKD prevalence rates from 3.8 to 8.4% [48, 49]. In a prospective Portuguese study, the prevalence of CKD was 5.9% in a cohort of 1281 patients using the creatinine (SCr)-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate GFR [50].…”