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Spectrum of chronic kidney disease in HIV‐infected patients
Author(s) -
Campbell LJ,
Ibrahim F,
Fisher M,
Holt SG,
Hendry BM,
Post FA
Publication year - 2009
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2008.00691.x
Subject(s) - medicine , kidney disease , renal function , diabetes mellitus , nephropathy , odds ratio , indinavir , cohort , endocrinology , human immunodeficiency virus (hiv) , immunology , sida , viral disease
Objectives The aim of the study was to investigate the prevalence and aetiology of chronic kidney disease (CKD) and trends in estimated glomerular filtration rate (eGFR) in HIV‐infected patients. Methods Ascertainment and review of CKD cases among patients attending King's College and Brighton Hospitals, UK were carried out. CKD was defined as eGFR <60 mL/min for ≥3 months. Longitudinal eGFR slopes were produced to examine trends in renal function before, during and after exposure to indinavir (IDV) or tenofovir (TFV). Results CKD prevalence was 2.4%. While HIV‐associated nephropathy accounted for 62% of CKD in black patients, 95% of CKD in white/other patients was associated with diabetes mellitus, hypertension, atherosclerosis and/or drug toxicity. Exposure to IDV or TFV was associated with an accelerated decline in renal function (4.6‐fold and 3.7‐fold, respectively) in patients with CKD. In patients initiating IDV, age ≥50 years increased the odds of CKD [odds ratio (OR) 4.9], while in patients initiating TFV, age ≥50 years (OR 5.4) and eGFR 60–75 mL/min (OR 17.2) were associated with developing CKD. Conclusion This study highlights the importance of metabolic and vascular disease to the burden of CKD in an ageing HIV‐infected cohort. In patients who developed CKD, treatment with IDV or TFV was associated with an accelerated decline in renal function.