Screening for chronic kidney disease in the ambulatory HIV population

Fülöp, Tibor; Olivier, Jake; Meador, Robert; Hall, Jesse; Islam, Nahidul; Mena, Leandro; Henderson, Harold; Schmidt, Darren

doi:10.5414/cnp73190

Cited by 14 publications

(17 citation statements)

References 19 publications

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“…17,18,40–42 REACH participants with abnormal urinary protein excretion were more likely to be young, underweight or normal weight, and non-black individuals. However, the association of race/ethnicity in these models is most likely a result of a small number of non-black individuals and should be interpreted cautiously.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

Aaron

Kempf

Christenson

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective In the United States (US), kidney dysfunction is prevalent in almost 30% of HIV-infected patients and is an independent predictor of mortality. Proteinuria and elevated serum cystatin C (eCysC) are used as markers of kidney disease in the general population; however, the prevalence of these markers in HIV-infected adolescents is largely unknown. Methods This study includes 304 HIV-infected adolescents from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort, an observational study of adolescents recruited from 13 US cities. Clinical and demographic characteristics of participants were evaluated as correlates of proteinuria, a urine protein to creatinine ratio (UP/Cr) of ≥200 mg/g. Select univariate predictors were assessed to determine the association with urinary protein excretion and serum cystatin C in multivariable linear regression models and proteinuria and elevated serum cystatin C (eCysC ≥ 75th percentile) in multivariable logistic regression models. Results Overall, 19.1% of the participants had proteinuria while 23.7% had an eCysC. Low CD4+ T-lymphocyte counts (<200 cells/mm3) were significantly associated with a greater UP/Cr in linear models and with proteinuria in logistic regression models. CD4+ T-lymphocyte counts <500 cells/mm3 were significantly associated with a greater serum cystatin C concentration in linear models and with eCysC in logistic regression models. Conclusion Proteinuria among HIV-infected adolescents in REACH was approximately two-fold greater than healthy US adolescents. Both proteinuria and eCysC are associated with CD4+ T-lymphocyte counts. Further studies investigating early markers of kidney disease and the association with immune status and inflammation in adolescents are needed.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

Aaron

Kempf

Christenson

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…While data from the Chelsea and Westminster HIV cohort did not show an association between TDF and kidney dysfunction [47], TDF-treated individuals in the Johns Hopkins Clinical Cohort experienced greater decline in creatinine clearance over a period of 3 years compared with persons not receiving TDF (-13.3 versus 7.5 ml/min) [48]. However, a more recent study from the Older age [9-11, 26-28, 55, 64, 65] Low CD4 cell count [9-11, 25, 27, 73] High HIV-RNA viral load [12,25,27] Diabetes mellitus (?) [ 10-12, 27, 55, 64, 65] Hypertension (?)…”

Section: Impact Of Antiretroviral Therapies On Kidney Functionmentioning

confidence: 94%

“…Lipoprotein concentrations, low CD4 cell count, and high HIV load are likely to be identified as specific risk factors for HIV-infected populations [9,10,[25][26][27]. In addition, co-infection with hepatitis C virus (HCV) is an important contributor to kidney disease in HIV-infected populations [10,25,28].…”

Section: Comorbiditiesmentioning

confidence: 99%

“…[ 10-12, 27, 55, 64, 65] Hypertension (?) [ 11,12,25,27,29,30] Hepatitis C virus co-infection (?) [ 25,55,73] Proteinuria [9-12, 26, 64, 65] Albuminuria [10,29,30,55] eGFR \90 ml/min/1.73 m 2 [29,55,64] Elevation of urinary tubular markers [57][58][59][60][61][62][63][64] Use of TDF [3,11,48,51,52,55] eGFR estimated glomerular filtration rate, TDF tenofovir disoproxil fumarate same clinical cohort demonstrated only minor differences in kidney function changes over time between HIV-infected patients starting HAART treatment with or without inclusion of TDF [49].…”

Section: Impact Of Antiretroviral Therapies On Kidney Functionmentioning

confidence: 99%

“…A simple yet most important clinical marker of kidney damage is sustained proteinuria or albuminuria. While 7.2-32.6% of HIV-infected individuals have proteinuria, which is mostly diagnosed based on urine dipstick examination [7,9,10,[24][25][26][27][28], 8.7-17.8% of these individuals have albuminuria, which is mostly defined according to the urinary albumin to creatinine ratio (ACR) [10,29,30]. The prevalence of renal dysfunction, defined as a sustained decrease in the estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m 2 for 3 months or more, varies from 3.5% to 9.7% depending on the social and demographic characteristics of the HIV population that is being studied [9][10][11][12]28].…”

Section: Epidemiology Of Hiv Infection and Its Kidney Diseasementioning

confidence: 99%

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How to manage HIV-infected patients with chronic kidney disease in the HAART era

2012

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As human immunodeficiency virus (HIV)-infected patients now live longer while receiving highly active antiretroviral therapy (HAART), chronic kidney disease (CKD) has emerged as a significant cause of morbidity and mortality among urban HIV population. Risk factors associated with CKD in such HIV-infected population include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, low CD4 cell count, and high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, remains an important cause of CKD among limited HIV population of African descent. The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern. In particular, the association of tenofovir with kidney disease has been an area of great interest. The findings regarding tenofovir's adverse effect on long-term kidney function vary among studies. Early identification and treatment of kidney disease is imperative for reducing the burden of patients requiring dialysis in HIV-infected populations. Periodic monitoring of urinary albumin excretion, tubular parameters such as low-molecular-weight proteinuria, and the estimated glomerular filtration rate may be useful for early diagnosis of patients at risk for incident CKD. This review focuses on recent developments in epidemiology, risk factors, identification, estimation, and management of CKD in HIV-infected population in the HAART era.

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Comparative Analysis of the New Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease Equations for Estimation of Glomerular Filtration Rate in HIV Type 1-Infected Subjects

Dąbrowska

Mikuła

Stańczak

et al. 2011

AIDS Research and Human Retroviruses

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Recently, a new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was presented as a better alternative to the modification of diet in renal disease (MDRD) formula for GFR estimation (eGFR) in patients with relatively well-preserved kidney function. The main objective of our study was to compare the eGFR results arrived by the new CKD-EPI to the older MDRD equation in antiretroviral (ARV)-naive and ARV-treated HIV-1-infected patients. The study was performed in 287 adult HIV-1-infected patients and was an evaluation comparing eGFR results based on age, gender, race, and serum creatinine. The biggest difference in estimated glomerular filtration rate (eGFR) measured by the two formulas was seen in ARV-naive men with well-preserved kidney function (p = 0.001). Moreover, we found a significant negative correlation between mean difference in eGFR measured by the two equations and the age of the studied subjects (r = -0.37, p < 0.001). No correlation was observed between mean difference in eGFR and HIV viral load (r = -0.15, p = 0.2). Independent of the equation used, a significant decrease of eGFR in ARV-treated in comparison to ARV-untreated HIV-1-infected patients was seen (p < 0.001). In conclusion, in HIV-1-infected subjects, especially in ARV-naive men with well-preserved kidney function, eGFR measured by MDRD and CKD-EPI formulas varies strongly following the method used. Such discrepancies may be important in everyday clinical practice and must be confirmed by additional studies using GFR measured with a reference method.

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Screening for chronic kidney disease in the ambulatory HIV population

Abstract: Background: In 2005, the Infectious

Cited by 14 publications

References 19 publications

Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

How to manage HIV-infected patients with chronic kidney disease in the HAART era

Comparative Analysis of the New Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease Equations for Estimation of Glomerular Filtration Rate in HIV Type 1-Infected Subjects

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