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Risk factors of chronic kidney disease in HIV-infected patients
Philippe Flandre1, Pascal Pugliese, Lise Cuzin
1INSERM UMR-S 943 Pierre & Marie Curie University, Paris, France.
Insights
Chronic kidney disease (CKD) is a significant risk for HIV-1 patients, particularly those exposed to specific antiretroviral drugs like tenofovir and abacavir. Close renal function monitoring is crucial for these individuals.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Chronic kidney disease (CKD) poses a significant health challenge in patients with human immunodeficiency virus type 1 (HIV-1) infection.
- Identifying risk factors for CKD is crucial for proactive management and improved patient outcomes in HIV-1 care.
Purpose of the Study:
- To determine the risk factors associated with the development of chronic kidney disease (CKD) in a large cohort of HIV-1-infected patients.
- To investigate the impact of antiretroviral therapies (ARVs) and other clinical factors on CKD incidence.
Main Methods:
- A prospective cohort study involving 7378 HIV-1-infected patients across seven French reference centers.
- CKD was defined as two consecutive estimated glomerular filtration rate (eGFR) measurements ≤60 ml/min/1.73 m² over at least 3 months.
- Cox's proportional hazards model with delayed entry was utilized to identify predictive factors for CKD development.
Main Results:
- The incidence of CKD was 349 cases out of 7378 patients between 1993 and 2006.
- Acute kidney injury (HR=2.40) and hypertension (HR=2.39) were strongly associated with increased CKD risk.
- Exposure to specific ARVs, including recent indinavir (HR=2.03), tenofovir (HR=1.55), and abacavir (HR=1.37), increased CKD risk. Past tenofovir exposure showed a higher risk (HR=2.23).
Conclusions:
- CKD is not uncommon in HIV-1-infected patients and is linked to exposure to certain ARVs.
- Abacavir, indinavir, and tenofovir were identified as ARVs associated with a higher risk of CKD.
- Enhanced renal function monitoring is recommended for HIV-1 patients exposed to these specific antiretroviral medications.
Background And Objectives:
The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients.
Design, Setting, Participants, & Measurements:
Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR ≤60 ml/min per 1.73 m² over ≥3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD.
Results:
From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm³ had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28).
Conclusions:
CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.
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