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Outcomes of HIV-infected Patients on Dialysis: Experience at a Tertiary Care Center
Ravi Prakash Deshpande1, Chetan Cs2, Ravinder Singh Bhadoria3
1Department of Nephrology, ST. Johns National Academy of Health Sciences, Bengaluru, Karnataka, India.
Insights
Human immunodeficiency virus (HIV)-positive patients with end-stage kidney disease (ESKD) on dialysis showed marginally better survival with continuous ambulatory peritoneal dialysis (CAPD) compared to hemodialysis (HD). Infection risks were noted in both groups, influenced by CD4 count and albumin levels.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) infection significantly increases the risk of end-stage kidney disease (ESKD).
- Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are established treatments for ESKD in HIV-positive patients.
- Managing dialysis in HIV-positive individuals presents unique challenges.
Purpose of the Study:
- To compare the outcomes of HIV-positive ESKD patients undergoing hemodialysis (HD) versus continuous ambulatory peritoneal dialysis (CAPD).
- To identify factors influencing mortality and infection rates in this patient population.
Main Methods:
- A retrospective study analyzed data from HIV-positive ESKD patients on HD or CAPD for at least one month.
- Data collection included dialysis charts, with analysis focusing on survival, mortality causes, and infection episodes.
Main Results:
- The study included 20 CAPD patients and 76 HD patients, with common ESKD causes being hypertension and diabetes.
- Mean survival was slightly higher in the CAPD group (20.94 months) compared to the HD group (15.46 months).
- The HD group experienced higher mortality within 12 months, primarily due to infections. CAPD patients with low albumin (<2.5 g/dl) had increased peritonitis rates.
Conclusions:
- Survival outcomes were marginally better for HIV-positive ESKD patients on CAPD.
- Low CD4 counts correlated with increased infections in both dialysis groups.
- Low albumin levels were associated with higher peritonitis rates in CAPD patients, highlighting the need for further research with larger PD cohorts and controls.
Background:
Human immunodeficiency virus (HIV) infection is a major public health problem. These patients are at an increased risk for end-stage kidney disease. Both hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are the accepted modalities of treatment.
Materials And Methods:
In this retrospective study, we included all HIV-positive end-stage kidney disease (ESKD) patients who were on dialysis - HD or CAPD - for at least 1 month. Data were collected from the dialysis charts and analyzed.
Results:
There were 20 patients in the CAPD group and 76 patients in the HD group. Mean age was 49.6 ± 8.73 years in the CAPD group and 46.28 ± 9.02 years in the HD group. Hypertension and diabetes were the common causes for ESKD. Mean survival was slightly better in CAPD group (20.94 vs. 15.46 months). The HD group had higher mortality within 12 months of dialysis initiation, and infection was the cause for early deaths. Mean infection episodes was 2.1 in HD group and 3.1 in CAPD group. CAPD patients with low albumin (<2.5 g/dl) had higher peritonitis rates.
Conclusion:
Managing HIV-positive dialysis patients remains challenging. In our study, survival was marginally better in the CAPD group. In both groups, low CD4 count was associated with more infections and low albumin with more peritonitis episodes. A study incorporating more peritoneal dialysis (PD) patients, longer follow-ups, and a matched non-HIV control will throw more light on patient outcomes.
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