[Prevalence of chronic kidney disease (CKD) and significant contributors to CKD in HIV-infected patients].
We investigated the prevalence of CKD and factors associated with CKD in HIV-infected patients who were under stable medical control. We retrospectively abstracted the medical records of 748 HIV-infected outpatients(659 males and 89 females). Their mean age was 44.9+/-11.7 (range; 21 to 79) years. The following parameters were reviewed: urinalysis including proteinuria and microscopic hematuria, urinary N-acetyl-beta-glucosaminidase (NAG) level as a marker of tubular damage, serum creatinine level, estimated glomerular filtration rate calculated based on the Modification of Diet in Renal Disease formula (eGFR), CD4 count in peripheral blood, HIV-RNA copies in serum, use and vintage of highly active antiretroviral therapy (HAART), and use of anti-hypertensive drugs (AHTD). Stages of CKD were determined based on the K/DOQI stages of kidney disease. Chronic renal failure (CRF) was defined as an eGFR value of less than 60 mL/min/1.73 m2. The chi-square test was used to evaluate differences in the prevalence of dichotomous variables. Multivariable logistic regression analysis was applied to assess independent contributors to existence of CRF, proteinuria, and tubular damage. Proteinuria was positive in 50.0 % and hematuria was positive in 11.3 %. Both were positive in 8.41%. Tubular damage (> 11 U/L of urinary NAG levels) was positive in 42 out of 112(37.5 %). Prevalence of CKD and CRF was 87.8 % and 16.2 %, respectively. Stages of CKD were: stage 5D, 4 patients (0.53 %); stage 5, 0 patients (0%); stage 4, 3 patients (0.40 %); stage 3, 114 patients (15.2 %); stage 2, 487 patients (65.1%); stage 1, 49 patients (6.6%); and non-CKD, 91 patients (12.2 %). Statistically, use of HAART, urinary NAG level, and age were significant contributors to proteinuria. Proteinuria, age, and use of AHTD were strong predictors for CRF. Tubular damage was related to HAART vintage, age, and TG levels. In addition, HAART vintage of more than 2.5 years was statistically associated with the existence of tubular damage in HIV-infected patients. Prevalence of CKD in stable HIV-infected patients was unexpectedly high in our hospital. Aged patients with a long HAART vintage who have proteinuria and hypertension are predisposed to the development of CRF through tubular damage.
Department of Nephrology, Tokyo Metropolitan Komagome General Hospital, Tokyo, Japan.
Yuya
Y
Nakamura
Asuka
A
Shibuya
Hitoe
H
Suzuki
Minoru
M
Ando
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology*; D007684:Kidney Tubules; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011507:Proteinuria / Q000150:complications; D012189:Retrospective Studies