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Incidence and Risk Factors for Renal Disease in an Outpatient Cohort of HIV-Infected Patients on Antiretroviral Therapy.

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Citation: KI Reports. 4(8):1075-1084, 2019 Aug.PMID: 31440698Institution: MedStar Washington Hospital CenterDepartment: Medicine/Infectious DiseasesForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2019 ISSN:

2468-0249

Name of journal: Kidney international reportsAbstract: Conclusion: Our study revealed a substantial burden of renal disease among HIV patients. Cumulative VL was associated with renal disease, suggesting that early VL suppression may decrease its incidence.Introduction: Prior studies found renal disease was common among HIV-infected outpatients. We updated incident renal disease estimates in this population, comparing those with and without tenofovir exposure.Methods: We conducted a retrospective analysis of the DC Cohort, a longitudinal study of HIV patients in Washington, DC, from 2011 to 2015. We included adults prescribed antiretroviral therapy (ART) with baseline glomerular filtration rate (GFR) >=15 ml/min per 1.73 m2. We defined renal disease as 50% decrease in GFR or doubled serum creatinine (Cr) within 3 months. We defined cumulative viral load as area under the curve (AUC) of log10 transformed longitudinal HIV RNA viral load (VL). Correlates of time to incident renal disease were identified using Cox proportional hazard regression models, adjusted for demographics and known risk factors for kidney disease.Results: Among 6068 adults, 77% were Black and median age was 48 years. Incident renal disease rate was 0.77 per 100 person-years (95% confidence interval [CI]: 0.65-0.9). Factors associated with renal disease were age (adjusted hazard ratio [aHR]: 1.4; CI 1.1-1.7 per 10 years), public non-Medicaid, non-Medicare insurance (aHR: 3.4; CI: 1.9-6.4), AUC VL (aHR: 1.1; CI: 1.1-1.2), diabetes mellitus (aHR: 1.6; CI: 1.0-2.4), and mildly reduced GFR (60-89 ml/min per 1.73 m2) (aHR: 1.5; CI: 1.0-2.3); recent tenofovir exposure was not associated with renal disease (aHR: 0.7; CI: 0.5-1.1).All authors: DC Cohort Executive Committee, Doshi S, Hart R, Hou Q, Terzian AS, Ucanda MFiscal year: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.ekir.2019.04.024

Date added to catalog: 2019-10-10

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31440698	Available		31440698

Conclusion: Our study revealed a substantial burden of renal disease among HIV patients. Cumulative VL was associated with renal disease, suggesting that early VL suppression may decrease its incidence.

Introduction: Prior studies found renal disease was common among HIV-infected outpatients. We updated incident renal disease estimates in this population, comparing those with and without tenofovir exposure.

Methods: We conducted a retrospective analysis of the DC Cohort, a longitudinal study of HIV patients in Washington, DC, from 2011 to 2015. We included adults prescribed antiretroviral therapy (ART) with baseline glomerular filtration rate (GFR) >=15 ml/min per 1.73 m2. We defined renal disease as 50% decrease in GFR or doubled serum creatinine (Cr) within 3 months. We defined cumulative viral load as area under the curve (AUC) of log10 transformed longitudinal HIV RNA viral load (VL). Correlates of time to incident renal disease were identified using Cox proportional hazard regression models, adjusted for demographics and known risk factors for kidney disease.

Results: Among 6068 adults, 77% were Black and median age was 48 years. Incident renal disease rate was 0.77 per 100 person-years (95% confidence interval [CI]: 0.65-0.9). Factors associated with renal disease were age (adjusted hazard ratio [aHR]: 1.4; CI 1.1-1.7 per 10 years), public non-Medicaid, non-Medicare insurance (aHR: 3.4; CI: 1.9-6.4), AUC VL (aHR: 1.1; CI: 1.1-1.2), diabetes mellitus (aHR: 1.6; CI: 1.0-2.4), and mildly reduced GFR (60-89 ml/min per 1.73 m2) (aHR: 1.5; CI: 1.0-2.3); recent tenofovir exposure was not associated with renal disease (aHR: 0.7; CI: 0.5-1.1).

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