Chronic kidney disease incidence, and progression to end-stage renal disease, in HIV-infected individuals: a tale of two races.
BACKGROUND
Little is known about the racial differences in the incidence and progression of HIV-related chronic kidney disease (CKD) that underlie African American-white disparities in HIV-related end-stage renal disease (ESRD).


METHODS
In a cohort in Baltimore, Maryland, we measured CKD incidence, glomerular filtration rate (GFR) slope, and progression to ESRD in 3332 African American and 927 white HIV-infected subjects.


RESULTS
A total of 284 subjects developed CKD, 100 (35%) of whom subsequently developed ESRD. African American subjects were at slightly increased risk for incident CKD, compared with white subjects (hazard ratio [HR], 1.9 [95% confidence interval {CI}, 1.2-2.8]). However, once CKD had commenced, the African American subjects developed ESRD markedly faster than did the white subjects (HR, 17.7 [95% CI, 2.5-127.0]), and, correspondingly, their GFR decline after diagnosis of CKD was 6-fold more rapid (P < .001). In the subset of African American subjects for whom kidney-biopsy data were available, progression to ESRD was significantly faster than that in white subjects with CKD, irrespective of the presence of HIV-associated nephropathy.


CONCLUSIONS
The results of this study suggest that African American-white disparities in HIV-related ESRD are explained predominantly by a more aggressive natural disease history in African Americans and less by racial differences in CKD incidence.
Lucas
Gregory M
GM
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicines, Baltimore, Maryland, USA. glucas@jhmi.edu
Lau
Bryan
B
Atta
Mohamed G
MG
Fine
Derek M
DM
Keruly
Jeanne
J
Moore
Richard D
RD
D016263:AIDS-Associated Nephropathy / Q000208:ethnology*; D000328:Adult; D001741:Black or African American; D015142:Baltimore / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D044465:White People