Baseline Kidney Function as Predictor of Mortality and Kidney Disease Progression in HIV-Positive Patients

• Published in: American journal of kidney diseases Vol. 60; no. 4; pp. 539 - 547
• Main Authors: Ibrahim, Fowzia, MSc, Hamzah, Lisa, MRCP, Jones, Rachael, MRCP, Nitsch, Dorothea, MD, MSc, Sabin, Caroline, PhD, Post, Frank A., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier; W.B. Saunders
• Subjects: AIDS-Associated Nephropathy - mortality; AIDS-Associated Nephropathy - physiopathology; Biological and medical sciences; chronic kidney disease; Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); competing risk; Disease Progression; Estimated glomerular filtration rate (eGFR); Female; Glomerular Filtration Rate; human immunodeficiency virus (HIV); Human viral diseases; Humans; Infectious diseases; Kidney - physiopathology; Kidneys; Male; Medical sciences; mortality; Nephrology; Nephrology. Urinary tract diseases; Original Investigation; Proportional Hazards Models; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Urinary system involvement in other diseases. Miscellaneous; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; mortality; Estimated glomerular filtration rate (eGFR); chronic kidney disease; human immunodeficiency virus (HIV); competing risk; Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); Nephrology; Renal function; Prognosis; Epidemiology; Epidermal growth factor receptor; Urology; Evolution; Kidney disease; Immunopathology; Urinary system disease; Mortality; Competing risk; Retroviridae; AIDS; Chronic kidney disease; Immune deficiency; Lentivirus; Glomerular filtration rate; Infection; Virus; Viral disease; Renal failure; Human immunodeficiency virus; Predictive factor
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.03.006

Background Chronic kidney disease (CKD) is associated with increased all-cause mortality and kidney disease progression. Decreased kidney function at baseline may identify human immunodeficiency virus (HIV)-positive patients at increased risk of death and kidney disease progression. Study Design Observational cohort study. Setting & Participants 7 large HIV cohorts in the United Kingdom with kidney function data available for 20,132 patients. Predictor Baseline estimated glomerular filtration rate (eGFR). Outcomes Death and progression to stages 4-5 CKD (eGFR <30 mL/min/1.73 m2 for >3 months) in Cox proportional hazards and competing-risk regression models. Results Median age at baseline was 34 (25th-75th percentile, 30-40) years, median CD4 cell count was 350 (25th-75th percentile, 208-520) cells/μL, and median eGFR was 100 (25th-75th percentile, 87-112) mL/min/1.73 m2 . Patients were followed up for a median of 5.3 (25th-75th percentile, 2.0-8.9) years, during which 1,820 died and 56 progressed to stages 4-5 CKD. A U-shaped relationship between baseline eGFR and mortality was observed. After adjustment for potential confounders, eGFRs <45 and >105 mL/min/1.73 m2 remained associated significantly with increased risk of death. Baseline eGFR <90 mL/min/1.73 m2 was associated with increased risk of kidney disease progression, with the highest incidence rates of stages 4-5 CKD (>3 events/100 person-years) observed in black patients with eGFR of 30-59 mL/min/1.73 m2 and those of white/other ethnicity with eGFR of 30-44 mL/min/1.73 m2. Limitations The relatively small numbers of patients with decreased eGFR at baseline and low rates of progression to stages 4-5 CKD and lack of data for diabetes, hypertension, and proteinuria. Conclusions Although stages 4-5 CKD were uncommon in this cohort, baseline eGFR allowed the identification of patients at increased risk of death and at greatest risk of kidney disease progression.