Survival during Renal Replacement Therapy among African Americans Infected with HIV Type 1 in Urban Baltimore, Maryland

Atta, Mohamed G.; Fine, Derek M.; Kirk, Gregory D.; Mehta, Shruti H.; Moore, Richard D.; Lucas, Gregory M.

doi:10.1086/523728

Cited by 34 publications

(29 citation statements)

References 25 publications

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“…This finding is contrary to results from a North American study demonstrating that the incidence of ESRD among Caucasians with HIV infection was similar to that among Caucasian patients without HIV infection [16]. This difference might be explained by the finding that most Caucasian patients with ESRD in our cohort were IDU and HCV-coinfected, whereas in most North American studies IDU and HCV coinfection were less prevalent in Caucasian patients with ESRD [19,21,28]. Accordingly, HCV and IDU were both identified as risk factors for ESRD in the univariate analysis of our cohort.…”

Section: Discussioncontrasting

confidence: 99%

“…In our study, the proportion of Caucasian patients with ESRD was higher than in most studies (74.4%) [16,22,24,[26][27][28]. We could not find any influence of HAART on the incidence of ESRD in Caucasians throughout the observation time.…”

Section: Discussioncontrasting

confidence: 82%

“…Thus, effective antiretroviral treatment became easier and safer for patients with renal impairment only very recently. The survival time of patients with ESRD was longer in our study compared with other studies, but lower rates of IDU (33.3% vs. 50 -65%, respectively) and HCV coinfection (38.5% vs. 67-68%, respectively) are the most likely explanations for this difference [19,21,22,28].It is well established that HAART lowers the incidence of HIVAN and thus ESRD in Black patients [16,18,19,34] but it is unclear whether this is true in Caucasian patients [25][26][27]. In our study, the proportion of Caucasian patients with ESRD was higher than in most studies (74.4%) [16,22,24,[26][27][28].…”

contrasting

confidence: 54%

“…Conversely, European cohorts consist of mostly Caucasian HIVinfected patients with various proportions of IDU and far fewer Black patients with almost no IDU [19,26,28].…”

Section: Introductionmentioning

confidence: 99%

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End‐stage renal disease and dialysis in HIV‐positive patients: observations from a long‐term cohort study with a follow‐up of 22 years

et al. 2012

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ObjectivesRenal disease is a common and serious complication in HIV-infected patients. MethodsA retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease (ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy (HAART)], 1997 (early HAART) and 2004. ResultsData for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years (PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk (RR) 5.1; 95% confidence interval (CI) 2.3-10.3; P < 0.0001], injecting drug use (IDU) (RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus (HCV) coinfection (RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up (PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 (RR 0.72; P = 0.52), but significantly from period 1 to 3 (RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality (RR 9.9; 95% CI 6.3-14.5; P < 0.0001). ConclusionAs a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD.Keywords: chronic kidney disease, haemodialysis, HIV-associated nephropathy, renal failure, renal replacement therapy Accepted 18 July 2012 IntroductionThe prevention and treatment of cardiovascular, liver and kidney diseases have increasingly been the focus of attention in attempts to reduce the morbidity and mortality of HIV-infected individuals [1]. In the USA, HIV-associated ESRD has become epidemic among Black patients [11,12]. Black individuals are more prone to kidney disease than any other ethnic group in the general [13,14] and HIV-infected populations, possibly as a consequence of predisposing genetic polymorphisms [15]. The risk of ESRD in Black HIV-infected individuals has been reported to be three-to six-fold higher than in Caucasian HIV-infected patients [7,16,17], reflecting the susceptibility of Black patients to develop HIVAN. The introduction of highly active antiretroviral therapy (HAART) has reduced the incidence of HIVAN and ESRD among Black patients [18][19][20], but the prevalence of ESRD is projected to further increase [11,12]. Earlier studies, mainly from the USA, concluded that, almost exclusively in Black patients, HIVAN is one of the major causes of ESRD [6,21,22], but histologica...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 82%

contrasting

confidence: 54%

“…Conversely, European cohorts consist of mostly Caucasian HIVinfected patients with various proportions of IDU and far fewer Black patients with almost no IDU [19,26,28].…”

Section: Introductionmentioning

confidence: 99%

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End‐stage renal disease and dialysis in HIV‐positive patients: observations from a long‐term cohort study with a follow‐up of 22 years

et al. 2012

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“…Although we did not observe an association between African-American race and proteinuria, this may reflect the small sample size of Caucasians, and the overall high prevalence of proteinuria in this cohort may at least in part reflect the predominance of African Americans. In previous studies, which drew from this and similar populations, strong associations were observed between African-American race and development of ESRD, and survival rates after dialysis initiation were poor (15,27). Early diagnosis and care for CKD may help to prevent more serious kidney damage, eventual kidney failure, and the need for dialysis.…”

Section: Discussionmentioning

confidence: 75%

HIV and Proteinuria in an Injection Drug User Population

Yanik

Lucas

Vlahov

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Proteinuria is a major determinant of chronic kidney disease. We aimed to characterize the prevalence and correlates of proteinuria in a cohort of HIV-infected and uninfected injection drug users.Design, setting, participants, & measurements: A cross-sectional analysis was performed among 902 injection drug users (273 HIV-infected) in the AIDS Linked to the Intravenous Experience cohort. The primary outcome was proteinuria defined as having a urine protein/creatinine concentration ratio >200 mg/g. Poisson regression with robust variance was used to determine prevalence ratios.Results: Overall, 24.8% of participants had proteinuria; the prevalence was 2.9 times higher among HIV-infected participants (45%) compared with HIV-uninfected participants (16%). In addition, age, health insurance, employment status, hepatitis B and C serostatus, diabetes, and high BP were associated with proteinuria. Neither antiretroviral therapy nor features of illicit drug use history were associated with proteinuria. In multivariate analysis, HIV infection, unemployment, increased age, diabetes, hepatitis C infection, and high BP were significantly associated with a higher prevalence of proteinuria.Conclusions: In an aging, predominantly African-American cohort of injection drug users, we found a striking burden of proteinuria that was strongly associated with HIV status. In addition to being a pathway to ESRD, proteinuria is a potent risk factor for cardiovascular morbidity and mortality. Evaluation of aggressive screening and disease-modification strategies in this high-risk population is warranted.

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Organ Transplantation in HIV Patients: Current Status and New Directions

Stosor

2013

Curr Infect Dis Rep

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Combination antiretroviral therapy has resulted in longer life expectancies in persons living with HIV; however, end organ disease and death from organ failure have become growing issues for this population. With effective therapies for viral suppression, HIV is no longer considered an absolute contraindication to organ transplantation. Over the past decade, studies of transplantation in patients with HIV have had encouraging results such that patients with organ failure are pursuing transplantation. This review focuses on the current status of organ transplantation for HIV-infected persons.

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Survival during Renal Replacement Therapy among African Americans Infected with HIV Type 1 in Urban Baltimore, Maryland

Cited by 34 publications

References 25 publications

End‐stage renal disease and dialysis in HIV‐positive patients: observations from a long‐term cohort study with a follow‐up of 22 years

End‐stage renal disease and dialysis in HIV‐positive patients: observations from a long‐term cohort study with a follow‐up of 22 years

HIV and Proteinuria in an Injection Drug User Population

Organ Transplantation in HIV Patients: Current Status and New Directions

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