Related Experiment Video
Updated: Jan 21, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Serious clinical events in HIV-positive persons with chronic kidney disease
Lene Ryom1, Jens D Lundgren, Matthew Law
1aDepartment of Infectious Diseases, CHIP, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark bThe Kirby Institute, University of New South Wales, Sydney, Australia cICAP-Columbia University and Harlem Hospital, New York, USA dUniversité Bordeaux, INSERM U 897, CHU de Bordeaux, Bordeaux, France eDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland fPublic Health Department, CHU Nice, Nice, France gDipartimento di Scienze della Salute, Clinica di Malattie Infectitive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy hCentre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, United Kingdom iAmsterdam University Medical Centers (location AMC), Department of Global Health and Division of Infectious Diseases, University of Amsterdam jHIV Monitoring Foundation, Amsterdam, The Netherlands kCHU Saint-Pierre, Department of Infectious Diseases, Brussels, Belgium.
Insights
HIV-positive individuals with chronic kidney disease (CKD) face a high risk of serious clinical events (SCE), including death and cardiovascular disease. Modifiable factors like smoking and diabetes significantly impact CKD prognosis in this population.
Area of Science:
- HIV Medicine
- Nephrology
- Epidemiology
Background:
- Predictors of chronic kidney disease (CKD) in HIV-positive individuals are known.
- Limited data exists on the prognosis of CKD in this population, particularly concerning modifiable risk factors.
Purpose of the Study:
- To investigate the prognosis of CKD in HIV-positive individuals.
- To identify the role of modifiable risk factors in serious clinical events (SCE) post-CKD diagnosis.
Main Methods:
- A prospective cohort study of D:A:D participants who developed CKD.
- Follow-up for incident serious clinical events (SCE), including end-stage renal disease (ESRD), cardiovascular disease (CVD), malignancies, and death.
- Poisson regression models were used to assess associations between SCE and modifiable risk factors.
Main Results:
- 595 individuals with CKD developed SCE during a median follow-up of 2.7 years.
- Smoking was associated with all CKD-related SCE.
- Diabetes predicted CVD, malignancies, and death; dyslipidemia predicted CVD; poor HIV status and low BMI predicted other AIDS and death; low eGFR predicted CVD and death.
Conclusions:
- HIV-positive individuals with CKD experience a high burden of serious clinical events.
- Several modifiable risk factors, including smoking and diabetes, play a significant role in CKD-related morbidity and mortality.
- Targeting these modifiable factors is crucial for improving outcomes in HIV-positive individuals with CKD.
Objectives:
Predictors of chronic kidney disease (CKD) amongst HIV-positive persons are well established, but insights into the prognosis after CKD including the role of modifiable risk factors are limited.
Design:
Prospective cohort study.
Methods:
D:A:D participants developing CKD (confirmed, >3 months apart, eGFR ≤ 60 ml/min per 1.73 m or 25% eGFR decrease when eGFR ≤ 60 ml/min per 1.73 m) were followed to incident serious clinical events (SCE); end stage renal and liver disease (ESRL and ESLD), cardiovascular disease (CVD), AIDS-defining and non-AIDS-defining malignancies (NADM), other AIDS or death, 6 months after last visit or 1 February 2016. Poisson regression models considered associations between SCE and modifiable risk factors.
Results:
During 2.7 (IQR 1.1-5.1) years median follow-up 595 persons with CKD (24.1%) developed a SCE [incidence rate 68.9/1000 PYFU (95% confidence interval 63.4-74.4)] with 8.3% (6.9-9.0) estimated to experience any SCE at 1 year. The most common SCE was death (12.7%), followed by NADM (5.8%), CVD (5.6%), other AIDS (5.0%) and ESRD (2.9%). Crude SCE ratios were significantly higher in those with vs. without CKD, strongest for ESRD [65.9 (43.8-100.9)] and death [4.8 (4.3-5.3)]. Smoking was consistently associated with all CKD-related SCE. Diabetes predicted CVD, NADM and death, whereas dyslipidaemia was only significantly associated with CVD. Poor HIV-status predicted other AIDS and death, eGFR less than 30 ml/min per 1.73 m predicted CVD and death and low BMI predicted other AIDS and death.
Conclusion:
In an era where many HIV-positive persons require less monitoring because of efficient antiretroviral treatment, persons with CKD carry a high burden of SCE. Several potentially modifiable risk factors play a central role for CKD-related morbidity and mortality.
More Related Videos
09:54Chronic, Acute, and Reactivated HIV Infection in Humanized Immunodeficient Mouse Models
Published on: December 3, 2019
13:58Amplifying and Quantifying HIV-1 RNA in HIV Infected Individuals with Viral Loads Below the Limit of Detection by Standard Clinical Assays
Published on: September 26, 2011
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management
01:22Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:29Acute Kidney Injury III: Clinical Manifestations