Serious clinical events in HIV-positive persons with chronic kidney disease
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Serious clinical events in HIV-positive persons with chronic kidney disease. / Ryom, Lene; Lundgren, Jens D; Law, Matthew; Kirk, Ole; El-Sadr, Wafaa; Bonnet, Fabrice; Weber, Rainer; Fontas, Eric; Monforte, Antonella d'Arminio; Phillips, Andrew; Reiss, Peter; de Wit, Stephane; Hatleberg, Camilla Ingrid; Sabin, Caroline; Mocroft, Amanda; D:A:D Study Group.
I: AIDS, Bind 33, Nr. 14, 2019, s. 2173-2188.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Serious clinical events in HIV-positive persons with chronic kidney disease
AU - Ryom, Lene
AU - Lundgren, Jens D
AU - Law, Matthew
AU - Kirk, Ole
AU - El-Sadr, Wafaa
AU - Bonnet, Fabrice
AU - Weber, Rainer
AU - Fontas, Eric
AU - Monforte, Antonella d'Arminio
AU - Phillips, Andrew
AU - Reiss, Peter
AU - de Wit, Stephane
AU - Hatleberg, Camilla Ingrid
AU - Sabin, Caroline
AU - Mocroft, Amanda
AU - D:A:D Study Group
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
U2 - 10.1097/QAD.0000000000002331
DO - 10.1097/QAD.0000000000002331
M3 - Journal article
C2 - 31385862
VL - 33
SP - 2173
EP - 2188
JO - AIDS
JF - AIDS
SN - 1350-2840
IS - 14
ER -
ID: 237849759