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Baseline kidney function as predictor of mortality and kidney disease progression in HIV-positive patients
Fowzia Ibrahim1, Lisa Hamzah, Rachael Jones
1King's College London, United Kingdom.
Insights
Baseline kidney function in HIV-positive patients can predict mortality and chronic kidney disease (CKD) progression. Lower or higher estimated glomerular filtration rates (eGFR) are linked to increased death risk, while reduced eGFR indicates higher CKD progression risk.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Chronic kidney disease (CKD) significantly increases mortality and disease progression risk in the general population.
- Identifying individuals with human immunodeficiency virus (HIV) who are at higher risk for adverse kidney outcomes is crucial for proactive management.
Purpose of the Study:
- To investigate the association between baseline kidney function, specifically estimated glomerular filtration rate (eGFR), and the risks of all-cause mortality and CKD progression in a large cohort of HIV-positive patients.
- To determine if baseline eGFR can serve as a predictor for identifying HIV-positive individuals at elevated risk for death and advanced kidney disease.
Main Methods:
- An observational cohort study was conducted using data from 7 large UK HIV cohorts, including 20,132 patients.
- Baseline estimated glomerular filtration rate (eGFR) was assessed as the primary predictor.
- Outcomes included all-cause mortality and progression to stages 4-5 CKD, analyzed using Cox proportional hazards and competing-risk regression models.
Main Results:
- A U-shaped relationship was observed between baseline eGFR and mortality, with eGFRs <45 and >105 mL/min/1.73 m(2) significantly associated with increased death risk after confounder adjustment.
- Baseline eGFR <90 mL/min/1.73 m(2) was linked to a higher risk of kidney disease progression.
- The highest incidence rates of advanced CKD were observed in black patients with eGFR 30-59 and white/other ethnicity patients with eGFR 30-44 mL/min/1.73 m(2).
Conclusions:
- Baseline eGFR is a valuable tool for identifying HIV-positive patients at increased risk of mortality.
- While progression to advanced CKD was uncommon, baseline eGFR effectively identified those at greatest risk.
- Limitations include small numbers of patients with low baseline eGFR and missing data on key comorbidities like diabetes and hypertension.
Background:
Chronic kidney disease (CKD) is associated with increased all-cause mortality and kidney disease progression. Decreased kidney function at baseline may identify human immunodeficiency virus (HIV)-positive patients at increased risk of death and kidney disease progression.
Study Design:
Observational cohort study.
Setting & Participants:
7 large HIV cohorts in the United Kingdom with kidney function data available for 20,132 patients.
Predictor:
Baseline estimated glomerular filtration rate (eGFR).
Outcomes:
Death and progression to stages 4-5 CKD (eGFR <30 mL/min/1.73 m(2) for >3 months) in Cox proportional hazards and competing-risk regression models.
Results:
Median age at baseline was 34 (25th-75th percentile, 30-40) years, median CD4 cell count was 350 (25th-75th percentile, 208-520) cells/microL, and median eGFR was 100 (25th-75th percentile, 87-112) mL/min/1.73 m(2). Patients were followed up for a median of 5.3 (25th-75th percentile, 2.0-8.9) years, during which 1,820 died and 56 progressed to stages 4-5 CKD. A U-shaped relationship between baseline eGFR and mortality was observed. After adjustment for potential confounders, eGFRs <45 and >105 mL/min/1.73 m(2) remained associated significantly with increased risk of death. Baseline eGFR <90 mL/min/1.73 m(2) was associated with increased risk of kidney disease progression, with the highest incidence rates of stages 4-5 CKD (>3 events/100 person-years) observed in black patients with eGFR of 30-59 mL/min/1.73 m(2) and those of white/other ethnicity with eGFR of 30-44 mL/min/1.73 m(2).
Limitations:
The relatively small numbers of patients with decreased eGFR at baseline and low rates of progression to stages 4-5 CKD and lack of data for diabetes, hypertension, and proteinuria.
Conclusions:
Although stages 4-5 CKD were uncommon in this cohort, baseline eGFR allowed the identification of patients at increased risk of death and at greatest risk of kidney disease progression.
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