Screening for chronic kidney disease in the ambulatory HIV population

In 2005, the Infectious Disease Society of America published a guideline recommending that all patients with human immunodeficiency virus (HIV) be screened for kidney disease. We initiated a screening program for kidney disease in a dedicated HIV clinic that follows 1,631 patients.

The screening consisted of a serum creatinine, an estimated glomerular filtration rate (eGFR) as defined by the abbreviated Modification of Diet in Renal Disease equation, and a standard urinalysis for proteinuria. Subjects were identified as having a positive screen if they had 1+ proteinuria or greater on a standard urinalysis or an eGFR of less than 60 ml/min/ 1.73 m2. After 1 year of screening, a retrospective chart review was conducted to determine the efficacy of screening. Bivariate associations were assessed for each outcome. A multiple logistic regression analysis was conducted first with main effects models and then for all variables and interactions.

941 subjects that did not have previously documented chronic kidney disease were screened and 96 (10.2%) met the definition of CKD. 9% of subjects had proteinuria and 2.4% had a qualifying eGFR. In multivariate analysis diabetes, hypertension, and low CD4 count (< 200 cells per mm3), low viral load (< 400 copies/ml) displayed strong associations with proteinuria. In the case of reduced eGFR, diabetes and age retained strong associations while the association with hypertension had borderline significance.

This study emphasizes the potential of similar screening programs to identify early or mild CKD in an ambulatory population of patients with HIV.