Abstract
Background
Chronic kidney disease (CKD) has become one of the most frequent non-infectious comorbidities in the aging HIV-infected population on long-standing combination antiretroviral therapy (cART).
Methods
We conducted a retrospective, cross-sectional study including HIV-infected adult patients attending our HIV outpatient clinic during the years 2017 and 2018 to assess prevalence and associated risk factors of CKD. Estimated glomerular filtration rate (eGFR) was measured by Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. CKD was diagnosed and classified according to the National Kidney Foundation guidelines. Logistic regression was employed to identify factors associated with CKD.
Results
We enrolled 2339 HIV-infected patients (91% were Caucasian) with a mean age of 45.3 years and a mean current CD4 lymphocyte count of 531 cells/mm3. CKD was diagnosed in 311 subjects (13.3%). Overall, 294 (12.6%) patients had albuminuria, 108 (4.6%) had eGFR < 60 mL/min/1.73 m2, and 78 (3.3%) had albuminuria plus eGFR < 60 mL/min/1.73 m2. Stages 4–5 of CKD were documented in 23 (1%) cases. Age greater than 50 years, male gender, hypertension, diabetes mellitus, high triglycerides, nadir CD4 cell count < 200 cells/mm3, current use of tenofovir disoproxyl fumarate (TDF) and of TDF plus a ritonavir-boosted protease inhibitors were independently associated with CKD, while current use of abacavir plus one integrase inhibitor was associated with a reduced risk of CKD.
Conclusion
There is a significant prevalence of CKD among HIV-infected persons in association with both traditional and HIV-specific risk factors, requiring a careful periodic monitoring of renal function in these patients.
Similar content being viewed by others
References
Collaboration Antiretroviral Therapy Cohort. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4:e349–e356356.
Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15:810–8.
Ekrikpo U, Kengne A, Bello A, et al. Chronic kidney disease in the global adult HIV-infected population: a systematic review and meta-analysis. PLoS One. 2018;13:e0195443.
Kooij KW, Vogt L, Wit FW, et al. Higher prevalence and faster progression of chronic kidney disease in human immunodeficiency virus-infected middle-aged individuals compared with human immunodeficiency virus-uninfected controls. J Infect Dis. 2017;216:622–31.
Rasmussen LD, May MT, Kronborg G, et al. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study. Lancet HIV. 2015;2:e288–e298298.
Woodward CL, Hall AM, Williams IG, et al. Tenofovir-associated renal and bone toxicity. HIV Med. 2009;10:482–7.
Hamzah L, Jose S, Booth JW, et al. Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate. J Infect. 2017;74:492–500.
Mocroft A, Lundgren JD, Ross M, et al. Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: a prospective international cohort study. Lancet HIV. 2016;3:e23–32.
Ryom L, Mocroft A, Kirk O, et al. Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals. AIDS. 2017;31:1261–70.
Ando M, Yanagisawa N. Epidemiology, clinical characteristics, and management of chronic kidney disease in human immunodeficiency virus-infected patients. World J Nephrol. 2015;4:388–95.
Bruggeman LA, Bark C, Kalayjan RC. HIV and the kidney. Curr Infect Dis Rep. 2009;11:479–85.
Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367:20–9.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.
Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Disease Society of America. Clin Infect Dis. 2005;40:1559–855.
Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease Work Group. KDIGO. clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;2013(3):1–150.
Lucas GM, Ross MJ, Stock PG, et al. Clinical practice guidelines for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e96–138.
Halle MP, Oumarou M, Kaze Folefack F, Mapoure Y, Mbatchou Ngahane BH, Luma Namme H. Prevalence and associated factors of chronic kidney disease among patients infected with human immunodeficiency virus in Cameroon. Iran J Kidney Dis. 2018;12:268–74.
Yanagisawa N, Muramatsu T, Koibuchi T et al (2018) Prevalence of chronic kidney disease and poor diagnostic accuracy of dipstick proteinuria in human immunodeficiency virus-infected individuals: a multicenter study in Japan. Open Forum Infect Dis 5:ofy216
Juega-Marino J, Bonjoch A, Perez-Alvarez N, et al. Prevalence, evolution, and related risk factors of kidney disease among Spanish HIV-infected individuals. Medicine (Baltimore). 2017;96:e7421.
Calza L, Vanino E, Magistrelli E, et al. Prevalence of renal disease within an urban HIV-infected cohort in Northern Italy. Clin Exp Nephrol. 2014;18:104–12.
Sutton SS, Magagnoli J, Cummings TH, Hardin JW, Edun B, Beaubrun A (2018) Chronic kidney disease, cardiovascular disease, and osteoporotic fractures in patients with and without HIV in the US Veteran’s Affairs Administration System. Curr Med Res Opin (Epub ahead of print)
Mocroft A, Kirk O, Reiss P, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS. 2010;24:1667–788.
Arribas JR, Thompson M, Sax PE, et al. Brief report: randomized, double-blind comparison of tenofovir alafenamide (TAF) vs tenofovir disoproxil fumarate (TDF), each coformulated with elvitegravir, cobicistat, and emtricitabine (E/C/F) for initial treatment: week 144 results. J Acquir Immune Defic Syndr. 2017;75:211–8.
Raffi F, Orkin C, Clarke A, et al. Brief report: long-term (96-week) efficacy and safety after switching from tenofovir disoproxil fumarate to tenofovir alafenamide in HIV-infected, virologically suppressed adults. J Acquir Immune Defic Syndr. 2017;75:226–31.
Achhra AC, Nugent M, Mocroft A, Ryom L, Wyatt CM. Chronic kidney disease and antiretroviral therapy in HIV-positive individuals: recent developments. Curr HIV/AIDS Rep. 2016;13:149–57.
Hamzah L, Jones R, Post FA. Optimizing antiretroviral regimens in chronic kidney disease. Curr Opin Infect Dis. 2019;32:1–7.
Maggi P, Montinaro V, Mussini C, et al. Novel antiretroviral drugs and renal function monitoring of HIV patients. AIDS Rev. 2014;16:144–51.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
There are no conflicts of interest.
Human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at the S.Orsola-Malpighi Hospital approval (approval number: 198/2017/O/Oss).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Calza, L., Sachs, M., Colangeli, V. et al. Prevalence of chronic kidney disease among HIV-1-infected patients receiving a combination antiretroviral therapy. Clin Exp Nephrol 23, 1272–1279 (2019). https://doi.org/10.1007/s10157-019-01768-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-019-01768-9