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Screening and management of renal disease in human immunodeficiency virus‐infected patients in A ustralia
Author(s) -
Gracey D.,
Chan D.,
Bailey M.,
Richards D.,
Dalton B.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2012.02933.x
Subject(s) - medicine , urinalysis , proteinuria , renal function , kidney disease , disease , observational study , prospective cohort study , cohort , intensive care medicine , pediatrics , kidney , urinary system
Background Renal disease has become one of the most important comorbidities observed in the human immunodeficiency virus ( HIV )‐infected patient cohort. Data are lacking on the current screening and management of renal disease in patients with HIV . We evaluated HIV ‐infected A ustralian adults in primary care to determine current practices. Methods This prospective, multicentre observational study included two rounds of data collection; the first was followed by an educational programme. Outcomes included screening for renal disease; management of risk factors for kidney disease and other comorbidities associated with renal disease. Results Fifty‐three general practitioners participated with 733 patients enrolled. Most were male (94%); almost 40% were 41–50 years of age, and 6% and 84% were receiving antiretroviral therapy. Comorbidities were common; 19% had hypertension, 5% were diabetic, 32% were dyslipidaemic, and 40% were smokers. Estimated glomerular filtration rate was commonly measured in both rounds of data collection (96% vs 95%). Proteinuria was assessed less frequently; this improved after education (48% vs 71%). Almost 10% of patients tested had proteinuria on urinalysis. Of the 45 patients (6%) with renal impairment (estimated glomerular filtration rate <60 m L /min), none was referred for assessment by a renal specialist. Conclusions This large observational study provides important information on renal disease in HIV ‐infected patients, an area with a paucity of clinical data. Current screening and management practices fall short of suggested guidelines. Failure to refer patients to specialists is a major deficiency. Improvements with education suggest the need to promote awareness of guidelines in primary care doctors.