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AIDS. 2017 Jun 1;31(9):1261-1270. doi: 10.1097/QAD.0000000000001464.

Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals.

Author information

1
aRigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Copenhagen, Denmark bResearch Department of Infection and Population Health, UCL, London, United Kingdom cAcademic Medical Center, Division of Infectious Diseases and Department of Global Health, University of Amsterdam dHIV Monitoring Foundation, Amsterdam, The Netherlands eDivision of Nephrology, Mount Sinai School of Medicine, New York, New York, USA fDepartment of Nephrology, Public Health Department, CHU Nice, Nice gUniversité Bordeaux, INSERM U 897, CHU de Bordeaux, Bordeaux, France hClinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland iThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

OBJECTIVES:

The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals.

DESIGN:

Prospective observational study.

METHODS:

The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m), stabilization (-10 to +10 ml/min per 1.73 m) and progression (<-10 ml/min per 1.73 m). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression.

RESULTS:

Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes.

CONCLUSION:

Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.

PMID:
28492392
DOI:
10.1097/QAD.0000000000001464
[Indexed for MEDLINE]

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