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Kidney Int Rep. 2018 May 8;3(5):1089-1099. doi: 10.1016/j.ekir.2018.04.014. eCollection 2018 Sep.

Lipodystrophy Increases the Risk of CKD Development in HIV-Positive Patients in Switzerland: The LIPOKID Study.

Author information

1
Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland.
2
Division of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
3
Clinical Research Center and Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland.
4
Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.
5
Division of Infectious Diseases and Hospital Hygiene, Kantonsspital Basel, University of Basel, Basel, Switzerland.
6
Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
7
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
8
Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.
9
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
10
Clinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland.
11
Division of Infectious Diseases, HIV Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

Abstract

Introduction:

Antiretroviral therapy has improved the life expectancy of patients living with HIV. However, lipodystrophy syndrome (LD) remains prevalent, affecting mostly patients treated with first-generation antiretroviral drugs. This syndrome is characterized by changes in body fat distribution with or without associated metabolic changes. Here, we studied whether clinically evaluated LD is independently associated with chronic kidney disease (CKD) development (sustained estimated glomerular filtration rate [eGFR] < 60 ml/min per 1.73 m2) in HIV-positive patients.

Methods:

We conducted a prospective cohort study (the LIPOKID Study) among all the patients from the Swiss HIV Cohort Study (SHCS) with an eGFR >60 ml/min per 1.73 m2 upon their entry into the cohort with more than 3 months of follow-up from January 2002 to August 2016. Cox regression models were used to estimate the association between LD and CKD development.

Results:

Among the 5384 patients included, 1341 (24.9%) developed LD during the follow-up. The mean follow-up time was 72.3 months (SD ±48.4). In total, 252 patients (4.7%) reached the primary endpoint after a median time of 51.3 months (±SD 39.9 months) from inclusion. A diagnosis of LD significantly increased the risk of an eGFR on univariate analysis (hazard ratio [HR] = 2.72; 95% confidence interval [95% CI] = 2.07-3.58; P < 0.001) and remained significantly higher after adjustment for known HIV and non-HIV risk factors for CKD (HR = 2.37; 95% CI = 1.67-3.36; P < 0.001). The effect of LD on CKD was not mediated through the use of nephrotoxic antiretroviral drugs.

Conclusion:

Lipodystrophy syndrome is independently associated with CKD after adjustment for previously reported risk factors.

KEYWORDS:

HIV; albuminuria; chronic kidney disease; lipids

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