Open AccessAdvanced renal disease, end‐stage renal disease and renal death among HIV‐positive individuals in Europe
Author(s) -
Ryom L,
Kirk O,
Lundgren J,
Reiss P,
Pedersen C,
De Wit S,
Buzunova S,
Gasiorowski J,
Gatell J,
Mocroft A
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18136
Subject(s) - medicine , end stage renal disease , dialysis , kidney disease , renal function , incidence (geometry) , renal replacement therapy , cause of death , peritoneal dialysis , disease , physics , optics
Many studies have focused on chronic kidney disease in HIV‐positive individuals, but few have studied the less frequent events, advanced renal disease (ARD) and end‐stage renal disease (ESRD). The aim of this study was to investigate incidence, predictors and outcomes for ARD/ESRD and renal death in EuroSIDA. ARD was defined as confirmed eGFR < 30 ml/min per 1.73 m 2 (>3 months apart) using Cockcroft‐Gault. ESRD was defined as hemo‐ or peritoneal dialysis>1 month/renal transplant. Renal deaths were defined as renal failure as the underlying cause of death, using CoDe methodology. Patients were followed from baseline (first eGFR after 1/1/2004) until last eGFR, ARD/ESRD/renal death; whichever occurred first. Poisson regression was used to identify predictors. 8817 persons were included, the majority were white (87.3%), males (73.9%) infected though homosexual contact (41.5%) and with a median age of 42 years (IQR 36–49). 45 persons (0.5%) developed the composite endpoint; ARD (24), ESRD (19) and renal death (2) during a median follow up (FU) of 4.5 years (IQR 2.7–5.8), incidence rate (IR) 1.21/1000 PYFU (95% CI 0.86–1.57). Of 312 persons (3.5%) with baseline eGFR<60 ml/min/1.73 m 2 , 13.3% (7.5–18.9) are estimated to develop ARD/ESRD/renal death within 6 years after baseline compared to 0.86% (0.58–1.1) of all patients, using Kaplan‐Meier methods. Predictors in multivariate analysis were older age (IRR 1.29 per 10 years [0.95–1.75]) any cardiovascular risk (IRR 2.34 [1.23–4.45]), CD4 count (IRR 0.76 per 2‐fold higher [0.60–0.97]) and eGFR (IRR 0.63 per 5 ml/min/1.73 m 2 higher [0.58–0.69]).Ethnicity, gender, nadir CD4, VL, HBV and using potential nephrotoxic antiretrovirals were insignificant in uni‐ and multivariate analysis. At 1 year after ARD/ESRD, 23.3% (CI 9.8–36.8) were estimated to have died using Kaplan‐Meier methods. The 11 deaths were from renal causes (2), non‐AIDS‐defining malignancies (2), hepatitis‐associated liver failure (1), respiratory failure (1), cardiovascular disease (1), pancreatitis (1) and unknown causes (3). The ARD/ESRD/renal death incidence was low in this population with the available FU, and was associated with traditional and HIV‐related risk factors. Most persons with ARD/ESRD/renal death had pre‐existing renal impairment, but some experienced a rapid progression from initial normal levels. Prognosis after ARD/ESRD was poor. Larger studies are required to address the possible contribution of specific antiretrovirals.