Chronic Kidney Disease Incidence, and Progression to End-Stage Renal Disease, in HIV-Infected Individuals: A Tale of Two Races

• Published in: The Journal of infectious diseases Vol. 197; no. 11; pp. 1548 - 1557
• Main Authors: Lucas, Gregory M., Lau, Bryan, Atta, Mohamed G., Fine, Derek M., Keruly, Jeanne, Moore, Richard D.
• Format: Journal Article
• Language: English
• Published: United States The University of Chicago Press 01.06.2008; University of Chicago Press
• Subjects: Adult; African Americans; AIDS; AIDS-Associated Nephropathy - ethnology; Baltimore - epidemiology; Black or African American; Chronic kidney failure; Epidemiology; Female; Glomerular Filtration Rate; Highly active antiretroviral therapy; HIV; HIV/AIDS; Humans; Incidence; Kidney diseases; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - ethnology; Kidneys; Male; Middle Aged; Proteinuria; Time Factors; White People; Baltimore
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/587994

Background. Little is known about the racial differences in the incidence and progression of HIV-related chronic kidney disease (CKD) that underlie African American—white disparities in HIV-related end-stage renal disease (ESRD). Methods. In a cohort in Baltimore, Maryland, we measured CKD incidence, glomerular filtration rate (GFR) slope, and progression to ESRD in 3332 African American and 927 white HIV-infected subjects. Results. A total of 284 subjects developed CKD, 100 (35%) of whom subsequently developed ESRD. African American subjects were at slightly increased risk for incident CKD, compared with white subjects (hazard ratio [HR], 1.9 [95% confidence interval {CI}, 1.2–2.8]). However, once CKD had commenced, the African American subjects developed ESRD markedly faster than did the white subjects (HR, 17.7 [95% CI, 2.5–127.0]), and, correspondingly, their GFR decline after diagnosis of CKD was 6-fold more rapid (P < .001). In the subset of African American subjects for whom kidney-biopsy data were available, progression to ESRD was significantly faster than that in white subjects with CKD, irrespective of the presence of HIV-associated nephropathy. Conclusions. The results of this study suggest that African American—white disparities in HIV-related ESRD are explained predominantly by a more aggressive natural disease history in African Americans and less by racial differences in CKD incidence.