The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study. (8th July 2020)

• Record Type: Journal Article
• Authors: Ryom, Lene; Lundgren, Jens D; Reiss, Peter; Ross, Mike; Kirk, Ole; Fux, Christophe A; Morlat, Phillipe; Fontas, Eric; Smith, Colette; De Wit, Stephane; d'Arminio Monforte, Antonella; El Sadr, Wafaa; Hatleberg, Camilla; Phillips, Andrew; Sabin, Caroline; Law, Matthew; Mocroft, Amanda
• Is Part Of: Journal of infectious diseases. Volume 223:Number 4(2021)
• Page Start: 632
• Page End: 637
• Publication Date: 2020-07-08
• Subjects: CKD -- chronic kidney disease -- eGFR -- renal -- HIV -- immunosuppression -- CD4; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiaa396
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Relations between different measures of human immunodeficiency virus–related immunosuppression and chronic kidney disease (CKD) remain unknown. Methods: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m 2 . Results: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68–.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24–.80]) vs 0.80 [95% CI, .70–.93]). Conclusions: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more. Abstract : While HIV-related immunosuppression duration and severity both predict chronic kidney disease (CKD), the duration association is strongest. CKD risk related to low CD4 count diminishes once immune function is restored, and most strongly affects persons with low estimated CKD risk.