Serious clinical events in HIV-positive persons with chronic kidney disease

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Lene Ryom
  • Lundgren, Jens
  • Matthew Law
  • Kirk, Ole
  • Wafaa El-Sadr
  • Fabrice Bonnet
  • Rainer Weber
  • Eric Fontas
  • Antonella d'Arminio Monforte
  • Andrew Phillips
  • Peter Reiss
  • Stephane de Wit
  • Camilla Ingrid Hatleberg
  • Caroline Sabin
  • Amanda Mocroft
  • D:A:D Study Group

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.

OriginalsprogEngelsk
TidsskriftAIDS
Vol/bind33
Udgave nummer14
Sider (fra-til)2173-2188
Antal sider16
ISSN0269-9370
DOI
StatusUdgivet - 2019

ID: 237849759