Format

Send to

Choose Destination
AIDS. 2019 Nov 15;33(14):2173-2188. doi: 10.1097/QAD.0000000000002331.

Serious clinical events in HIV-positive persons with chronic kidney disease.

Author information

1
Department of Infectious Diseases, CHIP, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
2
The Kirby Institute, University of New South Wales, Sydney, Australia.
3
ICAP-Columbia University and Harlem Hospital, New York, USA.
4
Université Bordeaux, INSERM U 897, CHU de Bordeaux, Bordeaux, France.
5
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
6
Public Health Department, CHU Nice, Nice, France.
7
Dipartimento di Scienze della Salute, Clinica di Malattie Infectitive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy.
8
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, United Kingdom.
9
Amsterdam University Medical Centers (location AMC), Department of Global Health and Division of Infectious Diseases, University of Amsterdam.
10
HIV Monitoring Foundation, Amsterdam, The Netherlands.
11
CHU Saint-Pierre, Department of Infectious Diseases, Brussels, Belgium.

Abstract

OBJECTIVES:

Predictors of chronic kidney disease (CKD) amongst HIV-positive persons are well established, but insights into the prognosis after CKD including the role of modifiable risk factors are limited.

DESIGN:

Prospective cohort study.

METHODS:

D:A:D participants developing CKD (confirmed, >3 months apart, eGFR ≤ 60 ml/min per 1.73 m or 25% eGFR decrease when eGFR ≤ 60 ml/min per 1.73 m) were followed to incident serious clinical events (SCE); end stage renal and liver disease (ESRL and ESLD), cardiovascular disease (CVD), AIDS-defining and non-AIDS-defining malignancies (NADM), other AIDS or death, 6 months after last visit or 1 February 2016. Poisson regression models considered associations between SCE and modifiable risk factors.

RESULTS:

During 2.7 (IQR 1.1-5.1) years median follow-up 595 persons with CKD (24.1%) developed a SCE [incidence rate 68.9/1000 PYFU (95% confidence interval 63.4-74.4)] with 8.3% (6.9-9.0) estimated to experience any SCE at 1 year. The most common SCE was death (12.7%), followed by NADM (5.8%), CVD (5.6%), other AIDS (5.0%) and ESRD (2.9%). Crude SCE ratios were significantly higher in those with vs. without CKD, strongest for ESRD [65.9 (43.8-100.9)] and death [4.8 (4.3-5.3)]. Smoking was consistently associated with all CKD-related SCE. Diabetes predicted CVD, NADM and death, whereas dyslipidaemia was only significantly associated with CVD. Poor HIV-status predicted other AIDS and death, eGFR less than 30 ml/min per 1.73 m predicted CVD and death and low BMI predicted other AIDS and death.

CONCLUSION:

In an era where many HIV-positive persons require less monitoring because of efficient antiretroviral treatment, persons with CKD carry a high burden of SCE. Several potentially modifiable risk factors play a central role for CKD-related morbidity and mortality.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center