The incidence of and risk factors for hospitalized acute kidney injury among people living with HIV on antiretroviral treatment

• Published in: HIV medicine Vol. 23; no. 6; pp. 611 - 619
• Main Authors: Muiru, Anthony N., Madden, Erin, Chilingirian, Ani, Rubinsky, Anna D., Scherzer, Rebecca, Moore, Richard, Villalobos, Celia P. Corona, Monroy Trujillo, Jose Manuel, Parikh, Chirag R., Hsu, Chi‐yuan, Shlipak, Michael G., Estrella, Michelle M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2022
• Subjects: acute kidney injury; Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Adult; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; CD4 antigen; chronic kidney disease; Confidence intervals; Creatinine; Epidemiology; Female; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Hospitalization; Human immunodeficiency virus; Humans; Hypertension; Incidence; Kidneys; Male; Proteinuria; Regression analysis; Regression models; Retrospective Studies; Risk analysis; Risk Factors; Serum albumin; Statistical analysis; chronic kidney disease; acute kidney injury; HIV; antiretroviral therapy; proteinuria
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.13216

Objectives The epidemiology of hospitalized acute kidney injury (AKI) among people living with HIV (PLWH) in the era of modern antiretroviral therapy (ART) for all PLWH is not well characterized. We evaluated the incidence of and risk factors for hospitalized AKI from 2005 to 2015 among PLWH on ART. Methods We conducted a retrospective analysis of PLWH from the Johns Hopkins HIV Clinical Cohort. We defined hospitalized AKI as a rise of ≥ 0.3 mg/dL in serum creatinine (SCr) within any 48‐h period or a 50% increase in SCr from baseline and assessed associations of risk factors with incident AKI using multivariate Cox regression models. Results Most participants (75%) were black, 34% were female, and the mean age was 43 years. The incidence of AKI fluctuated annually, peaking at 40 per 1000 person‐years (PY) [95% confidence interval (CI) 22–69 per 1000 PY] in 2007, and reached a nadir of 20 per 1000 PY (95% CI 11–34 per 1000 PY) in 2010. There was no significant temporal trend (−3.3% change per year; 95% CI −8.6 to 2.3%; P = 0.24). After multivariable adjustment, characteristics independently associated with AKI included black race [hazard ratio (HR) 2.44; 95% CI 1.42–4.20], hypertension (HR 1.62; 95% CI 1.09–2.38), dipstick proteinuria > 1 (HR 1.86; 95% CI 1.07–3.23), a history of AIDS (HR 1.82; 95% CI 1.29–2.56), CD4 count < 200 cells/µL (HR 1.46; 95% CI 1.02–2.07), and lower serum albumin (HR 1.73 per 1 g/dL decrease; 95% CI 1.02–2.07). Conclusions In this contemporary cohort of PLWH, the annual incidence of first AKI fluctuated during the study period. Attention to modifiable AKI risk factors and social determinants of health may further reduce AKI incidence among PLWH.