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Prevalence of chronic kidney disease in an urban HIV infected population
Sanjay K Fernando1, Fredric O Finkelstein, Brent A Moore
1Section of Nephrology, Department of Medicine, Hospital of Saint Raphael, New Haven, Connecticut, USA.
Insights
A significant number of HIV patients have chronic kidney disease (CKD), often undiagnosed. Hypertension and African American race are key risk factors for CKD in this population.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- The prevalence of chronic kidney disease (CKD) in HIV-infected individuals during the highly active antiretroviral therapy (HAART) era requires thorough evaluation.
- Understanding CKD burden is crucial for managing long-term health outcomes in the growing HIV-positive population.
Purpose of the Study:
- To determine the prevalence of CKD among HIV-infected patients.
- To identify risk factors associated with CKD in this population.
- To assess the clinical recognition of CKD in HIV-infected patients.
Main Methods:
- Retrospective chart review of HIV-infected patients from 2004.
- Utilized National Kidney Foundation's CKD staging criteria and Modification of Diet in Renal Disease (MDRD) formula for Glomerular Filtration Rate (GFR) calculation.
- Performed univariate and multivariate analyses to identify CKD predictors.
Main Results:
- CKD was found in 24% of HIV-infected patients, with varying stages.
- African American race, older age, AIDS diagnosis, lower CD4 counts, higher HIV viral load, hypertension (HTN), and diabetes mellitus (DM) were associated with CKD.
- Indinavir or tenofovir exposure was linked to CKD; HTN, AA race, or HTN and DM were significant predictors in multivariate analysis.
- Physicians failed to identify CKD in 74% of cases; HIV-associated nephropathy was diagnosed in 50% of renal biopsies.
Conclusions:
- A substantial proportion of HIV-infected patients have CKD, frequently unrecognized by clinicians.
- Hypertension, African American race, and co-existing diabetes mellitus are significant risk factors for CKD in HIV-positive individuals.
- Improved screening and clinical awareness are essential for managing CKD in the HIV population.
Background:
The prevalence of chronic kidney disease in an HIV-infected population during the highly active antiretroviral era has not been fully evaluated.
Methods:
A retrospective chart review of HIV-infected patients seen in 2004 was conducted to determine the prevalence of chronic kidney disease (CKD), using the 2004 National Kidney Foundation's CKD staging criteria. Glomerular filtration rate (GFR) was calculated, using the Modification of Diet in Renal Disease formula. Univariate analyses were performed comparing individuals with normal kidney function and those with CKD. Multivariate analysis was conducted including all variables with a value of P < 0.1.
Results:
We found evidence of CKD in 24% of the patients. Forty patients (10%) had stage 1 CKD, 19 patients (4%) stage 2, 29 patients (7%) stage 3, 4 patients (1%) stage 4, and 8 patients (2%) stage 5. Patients with CKD are more likely to be African American (AA), older, have AIDS, lower CD4 counts and higher HIV viral loads. Patients with CKD were also more likely to have hypertension (HTN), diabetes mellitus (DM), or both. Indinavir or tenofovir exposure was associated with CKD. In multivariate analysis HTN, AA race, or HTN and DM were the only significant predictors of CKD. Physicians did not identify CKD in 74% of patients. Renal biopsies were done in 10 patients; 5 had HIV-associated nephropathy.
Conclusions:
Substantial minorities of HIV-infected patients have CKD. AA race or the presence of HTN or HTN and DM is associated with CKD. Clinicians often do not note the presence of CKD in this population.
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