Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care

Abstract

Objective To examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Methods Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes. Results Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from −2.18 to −1.37 ml/min per 1.73 m2 per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m2 was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold <60 ml/min per 1.73 m2: 3.35 (95% confidence interval (CI) = 1.40–8.02)], which developed in 5.7% of patients after 4 years of exposure to this regimen-type. Conclusion ART was associated with reduced CKD risk in association with CD4 cell restoration and plasma viral load suppression, despite an increased CKD risk that was associated with initial regimens that included tenofovir and rPI.

Prevalence of Chronic Kidney Failure and Associated Factors in Patients Treated by Antiretroviral in the National Teaching Hospital of Cotonou

“…We can also mention that the intensity of digestive disorders arising from the use of didanosine limit adequate hydration of patients which could lead to chronic kidney failure. In most studies, the molecules ARV most often associated with chronic kidney disease are tenofovir, indinavir, ritonavir and abacavir [7,25].…”

Examination of Potential Modifiers of the Association of APOL1 Alleles with CKD Progression

“…Although individuals with two APOL1 high-risk alleles have a 4.25% lifetime risk of developing FSGS, those additionally infected with HIV have a 50% lifetime risk of developing HIVAN (6). Moreover, control of HIV infection with highly active antiretroviral therapy reduces the risk of CKD in patients with the APOL1 high-risk genotype (8)(9)(10). In another example, Divers et al (11) reported that the presence of JC viruria may be protective against kidney disease among individuals with two APOL1 high-risk alleles.…”

Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients

“…16 Another study documented a decreased CKD risk in association with CD4 cell restoration and plasma viral load suppression during treatment with HAART. 23 In our HIV population, the presence of albuminuria was the main factor associated with CKD (defined by the eGFR criterion). The presence of albuminuria is frequent and is observed in up to a third of patients infected with HIV.…”