Risk factors of chronic kidney disease in HIV-infected patients

  • Flandre P
  • Pugliese P
  • Cuzin L
 et al. 
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Abstract

BACKGROUND AND OBJECTIVES: The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR /=3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD. RESULTS: From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naive. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm(3) had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28). CONCLUSIONS: CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.

Author-supplied keywords

  • Adult
  • Anti-Retroviral Agents/adverse effects
  • Chronic Disease
  • Female
  • France/epidemiology
  • Glomerular Filtration Rate
  • HIV Infections/diagnosis/drug therapy/ epidemiolog
  • HIV-1/ isolation & purification
  • Humans
  • Kidney Diseases/diagnosis/ epidemiology/physiopath
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors

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Authors

  • P Flandre

  • P Pugliese

  • L Cuzin

  • C I Bagnis

  • I Tack

  • A Cabie

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