Race, kidney disease progression, and mortality risk in HIV-infected persons

The burden of HIV-associated chronic kidney disease (CKD) is growing in the United States, partially because of increased HIV-infection rates among African Americans. We determined the prevalence, incidence, and risk of rapid estimated GFR (eGFR) decline, ESRD, and death among HIV-infected (HIV+) African-American and non-African-American individuals cared for at the Comprehensive Care Center in Nashville, Tennessee, from January 1, 1998, through December 31, 2005.

Mixed effects, competing risks, and Poisson and Cox regression models were used to assess the risk of rapid eGFR decline (defined as ≥50% decrease in baseline eGFR), CKD5/ESRD, and death. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate eGFR. Confounders were adjusted with a propensity score that related patient characteristics to the probability of being African American. Mixed effects models compared the rate of rapid eGFR decline for HIV-infected African Americans and non-African Americans.

There were 2468 HIV-infected individuals in the study: 33% African American; 21% female. Among all patients, HIV-infected African Americans did not have a statistically significant increased risk for rapid eGFR decline compared with non-African Americans. However, African Americans had a significantly higher risk of ESRD and tended toward a higher risk of death.

HIV-infected African Americans did not have a statistically significant difference in the risk of eGFR decline when compared with HIV-infected non-African Americans. The findings in this study have potential public health significance.