Advanced chronic kidney disease, end‐stage renal disease and renal death among HIV ‐positive individuals in E urope

Objectives Knowledge about advanced chronic kidney disease ( CKD ) and end‐stage renal disease ( ESRD ) in HIV ‐positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD / ESRD and renal death. Methods Advanced CKD was defined as confirmed (two consecutive measurements ≥ 3 months apart) estimated glomerular filtration rate ( eGFR ) ≤ 30 mL/min/1.73 m 2 using C ockcroft− G ault, and ESRD as haemodialysis or peritoneal dialysis for ≥ 1 month or renal transplant. Renal death was death with renal disease as the underlying cause, using C oding C auses of D eath in HIV ( C o D e) methodology. Follow‐up was from 1 J anuary 2004 until last eGFR measurement, advanced CKD , ESRD or renal death, whichever occurred first. Poisson regression was used to identify predictors. Results Of 9044 individuals included in the study, 58 (0.64%) experienced advanced CKD / ESRD /renal death [incidence rate 1.32/1000 person‐years of follow‐up ( PYFU ); 95% confidence interval ( CI ) 0.98–1.66]; 52% of those who experienced the endpoint had a baseline eGFR  ≤ 60 mL/min/1.73 m 2 compared with 3% of those who did not. Using Kaplan−Meier methods, at 6 years from baseline, 0.83% (95% CI 0.59–1.07%) were estimated to have experienced the endpoint overall and 11.26% (95% CI 6.75–15.78%) among those with baseline eGFR ≤ 60 mL/min/1.73 m 2 . Independent predictors of the endpoint included any cardiovascular event [incidence rate ratio ( IRR ) 2.16; 95% CI 1.24–3.77], lower eGFR ( IRR 0.64 per 5 mL/min/1.73 m 2 ; 95% CI 0.59–0.70) and lower CD4 count ( IRR 0.77 per doubling; 95% CI 0.62–0.95). One year after experiencing advanced CKD or ESRD , an estimated 19.21% (95% CI 7.84–30.58%) of patients had died, mostly from extra‐renal causes. Conclusions The incidence of advanced CKD / ESRD /renal death was low and predictors included traditional renal risk factors, HIV ‐related factors and pre‐existing renal impairment. The prognosis following advanced CKD / ESRD was poor. Larger studies should address possible contributions of specific antiretrovirals.