Risk Factors of Chronic Kidney Disease in HIV-infected Patients

The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients. Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined...

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Published in:	Clinical journal of the American Society of Nephrology 2011-07, Vol.6 (7), p.1700-1707
Main Authors:	Flandre, Philippe, Pugliese, Pascal, Cuzin, Lise, Bagnis, Corinne Isnard, Tack, Ivan, Cabié, André, Poizot-Martin, Isabelle, Katlama, Christine, Brunet-François, Cécile, Yazdanpanah, Yazdan, Dellamonica, Pierre
Format:	Article
Language:	eng
Subjects:	Adult Anti-Retroviral Agents - adverse effects Chronic Disease Female France - epidemiology Glomerular Filtration Rate HIV Infections - diagnosis HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - virology HIV-1 - isolation & purification Humans Kidney Diseases - diagnosis Kidney Diseases - epidemiology Kidney Diseases - physiopathology Male Middle Aged Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Time Factors
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Summary:	The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients. Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR ≤60 ml/min per 1.73 m² over ≥3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD. From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm³ had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28). CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.
ISSN:	1555-9041 1555-905X