The incidence and dynamic risk factors of chronic kidney disease among people living with HIV – A population-based Cohort Study

Abstract

Objectives: We investigate the incidence of chronic kidney disease (CKD) among people living with HIV (PLWH) and the dynamic risk factors associated with CKD incidence. Design: A population-based cohort study of PLWH in South Carolina. Methods: Adults (age ≥18yrs) PLWH diagnosed between 2006 and 2019 who were CKD-free at baseline were included. The associations of HIV-related risk factors and conventional risk factors with the incidence of CKD were investigated during the overall study period and by different follow-up periods (i.e., 5-, 10-, and 15-years) by multivariate logistic regression. Results: Among 9,514 PLWH, the incidence of CKD was 12.39 per 1000 person-years. The overall model indicated that conventional risk factors, such as hypertension, dyslipidemia, cardiovascular disease, and diabetes were significantly associated with higher risk of developing CKD. HIV-related characteristics, such as high percent of days with viral suppression, recent CD4 count, and percent of retention in care, were associated with a lower risk of CKD compared to their counterparts. In the subgroup analysis, the results were similar for the 5-year and 6–10 years follow-up groups. Among patients who did not develop CKD by the 10th year, the risk factors for developing CKD within 11–15 years were dyslipidemia, diabetes, low recent CD4 count, and short duration of retention in care while other predictors vanished. Conclusions: Diabetes, CD4 count, and retention in care were persistently associated with CKD despite of follow-up duration. Closely monitoring diabetes and improving CD4 count and retention in care are important to lower the risk of CKD in PLWH.

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors

“…The CD4 þ cell count was classified as <200, 200-350, and >350 cells/mm 3 . Additionally, we considered the duration of viral suppression (percentage of days with viral suppression [<200 copies/ml]), and the duration of immunodeficiency (percentage of days with low CD4 þ cell count [<500 cells/mm 3 ]) as predictors as defined in previous studies [34,35]. In addition, the HIV diagnosis year, and the clinical AIDS diagnosis at the time of HIV diagnosis were also extracted as predictors.…”