Deteriorating renal function and clinical outcomes in HIV-positive persons

Area of Science:

• Nephrology
• Infectious Diseases
• Epidemiology

Background:

• Chronic kidney disease is a growing concern in HIV-positive individuals.
• Renal function decline impacts overall health and survival in people living with HIV.

Purpose of the Study:

• To investigate the association between renal function measures and clinical outcomes in HIV-positive patients.
• To determine if current estimated glomerular filtration rate (eGFR) and proportion of follow-up with low eGFR (%FU ≤60 ml/min) predict mortality, AIDS, and non-AIDS events.

Main Methods:

• An observational, longitudinal cohort study involving 12,155 participants from the EuroSIDA cohort.
• Utilized CKD-EPI formula for eGFR calculation and Poisson regression for prognostic marker analysis.
• Included individuals with at least one eGFR measurement post-January 1, 2004.

Main Results:

• Lower current eGFR (≤30 ml/min) strongly predicted death (aIRR 4.35) and non-AIDS events (aIRR 3.63).
• Increased proportion of follow-up with low eGFR (%FU ≤60 ml/min) was associated with higher incidence of death, non-AIDS, and AIDS events.
• Crude mortality incidence increased significantly with declining eGFR levels.

Conclusions:

• Both current eGFR and %FU ≤60 ml/min are associated with increased mortality and non-AIDS events in HIV-positive individuals.
• Findings underscore the link between renal dysfunction, morbidity, and mortality in HIV infection.
• Potential for reverse causality warrants consideration in interpreting results.