Human immunodeficiency virus/acquired immunodeficiency syndrome-associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival in the pre highly active antiretroviral therapy era.
BACKGROUND
The patient characteristics and course of HlV/AIDS-associated nephropathy (HIVAN) are presented for a national sample of end-stage renal disease (ESRD).


METHODS
375,152 patients in the United States Renal Data System were initiated on ESRD therapy between 1 January 1992 and 30 June 1997 and analyzed in an historical cohort study of HIVAN.


RESULTS
Of the study population, 3653 (0.97%) had HIVAN. Among patients with HIVAN, 87.8% were African American. HIVAN had the strongest association with African American race compared to other causes of renal failure except sickle cell anemia in logistic regression analysis (odds ratio 12.20, 95% confidence interval (CI) 10.57-14.07). In a separate logistic regression analysis, HIVAN was associated with male gender, decreased age (39.32 +/- 8.51 vs. 60.97 +/- 16.43 years, p<0.01 by Student's t-test), weight, body mass index, hemoglobin, albumin, decreased rate of pre-dialysis erythropoietin use, increased creatinine, decreased hypertension and increased rate of no medical insurance. The geographic distribution of HIVAN was similar to the distribution of HIV cases nationally. Two-year all cause unadjusted survival was 36% for HIVAN vs. 64% for all other patients with ESRD. HIVAN was associated with decreased patient survival in Cox regression analysis (hazard ratio for mortality 5.74, 95% CI, 5.40-6.10).


CONCLUSIONS
HIVAN had the strongest association with African American race of all causes of renal failure among patients on maintenance dialysis. HIVAN was associated with decreased patient survival after initiation of dialysis, which may be associated with poorer medical condition at initiation of dialysis.
Abbott
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KC
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. kevin.abbott@na.amedd.army.mil
Hypolite
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I
Welch
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PG
Agodoa
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LY
D016263:AIDS-Associated Nephropathy / Q000208:ethnology*; D000328:Adult; D044383:Black People; D015992:Body Mass Index; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000208:ethnology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D001741:Black or African American