Is dialysis modality a factor in survival of patients with ESRD and HIV-associated nephropathy?
BACKGROUND
Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN), characterized by a fulminant form of focal segmental glomerulosclerosis, has become the third leading cause of end-stage renal disease (ESRD) in young African Americans. There is a theoretical possibility that hemodialysis (HD) therapy in these patients may enhance HIV replication through the activation of white blood cells and release of such cytokines as tumor necrosis factor-alpha, interleukin-1, and interleukin-6, which have been found to increase HIV replication in vitro. We therefore determined whether dialysis modality is a factor in the survival of patients with HIVAN and ESRD.


METHODS
Information regarding dialysis modality was available for 6,053 of 6,166 patients with ESRD and HIVAN who started dialysis therapy in the United States from December 1995 to December 1999 by using the US Renal Data System database.


RESULTS
Eighty-nine percent were black. Eighty-eight percent underwent HD, and 12%, peritoneal dialysis (PD). On Cox-proportional hazard analysis, after adjusting for demographic variables and year of dialysis therapy initiation, there was no difference in survival between the different modalities (PD versus HD: hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.13). In addition, on censoring patients at the time of first dialysis modality switch, no difference in survival was found between PD and HD.


CONCLUSIONS
We conclude that patients with HIVAN and ESRD should be given an option to choose dialysis modality because it is not a factor in predicting survival.
Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, TX, USA. tahuja@utmb.edu
Tejinder S
TS
Ahuja
Neil
N
Collinge
James
J
Grady
Shilpi
S
Khan
D016263:AIDS-Associated Nephropathy / Q000401:mortality / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D016019:Survival Analysis; D015996:Survival Rate