Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus–Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus–Uninfected Controls. (13th June 2017) - Kooij, Katherine W
Summary: In this cohort of human immunodeficiency virus (HIV)–infected and HIV-uninfected individuals aged ≥45 years, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Compared with HIV-uninfected individuals, HIV-infected individuals on combination antiretroviral therapy were more likely to experience estimated glomerular filtration rate decline and worsening albuminuria during 4 years of follow-up. Abstract: Background: Human immunodeficiency virus (HIV)–infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute. Methods: We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m 2 ), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEh IV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category). Results: Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0–4.4), albuminuria (aOR = 5.8; 95% CI = 3.7–9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9–10.2]). Among 479 HIV-infected and 377 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (−0.56; 95% CI = −0.87 to −0.24 mL/min/1.73m 2 /year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3–4.0). Conclusions: In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus–infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.