HIV Care and the Incidence of Acute Renal Failure

• Published in: Clinical infectious diseases Vol. 47; no. 2; pp. 242 - 249
• Main Authors: Roe, Jennifer, Campbell, Lucy J., Ibrahim, Fowzia, Hendry, Bruce M., Post, Frank A.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.07.2008; University of Chicago Press; Oxford University Press
• Subjects: Acute kidney failure; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Adult; African Continental Ancestry Group; AIDS; AIDS-Related Opportunistic Infections - complications; Anti-Retroviral Agents - adverse effects; Antiretroviral Therapy, Highly Active - adverse effects; Biological and medical sciences; Clinical medicine; Epidemiology; Female; Hepatitis C - complications; Hepatitis C virus; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - complications; HIV Infections - drug therapy; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Incidence; Infections; Infectious diseases; Injections; Kidney - blood supply; Kidney diseases; Kidney failure; Kidneys; Logistic Models; Male; Medical sciences; Multivariate Analysis; Nadir; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Retrospective Studies; Risk Factors; Sexual Behavior; Statistics, Nonparametric; Substance Abuse, Intravenous - complications; T lymphocytes; T-Lymphocytopenia, Idiopathic CD4-Positive - complications; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; London England; Kidney disease; Immunopathology; Urinary system disease; Retroviridae; AIDS; Epidemiology; Immune deficiency; Lentivirus; Acute renal failure; Incidence; Infection; Virus; Viral disease; Human immunodeficiency virus
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/589296

Background. The clinical epidemiology of acute renal failure (ARF) in human immunodeficiency virus (HIV)-infected patients remains poorly defined. Methods. We conducted a retrospective analysis of patients who developed ARF while attending King's College Hospital (London, United Kingdom) during January 1998-December 2005. Serum creatinine level and estimated glomerular filtration rate were used to identify ARF. ARF episodes were classified as early onset if they occurred <3 months after initiation of HIV care and as late onset if they occurred ⩾3 months after initiation of HIV care. Results During the study period, 130 (5.7%) of 2274 patients developed 144 episodes of ARF. The incidences of early-onset and late-onset ARF were 19.3 episodes per 100 person-years (95% confidence interval [CI], 15.4–24.1 episodes per 100 person-years) and 1.1 episodes per 100 person-years (95% CI, 0.83–1.49 episodes per 100 person-years), respectively (rate ratio, 17.4; P<.001). In multivariate analysis, nadir CD4 T cell count <100×109 cells/L (odds ratio [OR], 6.7; 95% CI, 2.5–18.3) and acquired immunodeficiency syndrome (OR, 6.7; 95% CI, 3.4–13.3) were associated with early-onset ARF, whereas injection drug use (OR, 4.8; 95% CI, 1.3–17.7), hepatitis C virus coinfection (OR, 3.4; 95% CI, 1.3–8.6), and nadir CD4 T cell count <100×109 cells/L (OR, 5.8; 95% CI, 2.5–13.4) were associated with late-onset ARF. Conclusions. ARF was common and was associated with advanced immunodeficiency. The incidence of ARF decreased >10-fold in patients who had received HIV care for ⩾3 months.