Spectrum of chronic kidney disease in HIV-infected patients.
OBJECTIVE
The aim of the study was to investigate the prevalence and aetiology of chronic kidney disease (CKD) and trends in estimated glomerular filtration rate (eGFR) in HIV-infected patients.


METHODS
Ascertainment and review of CKD cases among patients attending King's College and Brighton Hospitals, UK were carried out. CKD was defined as eGFR <60 mL/min for > or =3 months. Longitudinal eGFR slopes were produced to examine trends in renal function before, during and after exposure to indinavir (IDV) or tenofovir (TFV).


RESULTS
CKD prevalence was 2.4%. While HIV-associated nephropathy accounted for 62% of CKD in black patients, 95% of CKD in white/other patients was associated with diabetes mellitus, hypertension, atherosclerosis and/or drug toxicity. Exposure to IDV or TFV was associated with an accelerated decline in renal function (4.6-fold and 3.7-fold, respectively) in patients with CKD. In patients initiating IDV, age > or =50 years increased the odds of CKD [odds ratio (OR) 4.9], while in patients initiating TFV, age > or =50 years (OR 5.4) and eGFR 60-75 mL/min (OR 17.2) were associated with developing CKD.


CONCLUSIONS
This study highlights the importance of metabolic and vascular disease to the burden of CKD in an ageing HIV-infected cohort. In patients who developed CKD, treatment with IDV or TFV was associated with an accelerated decline in renal function.
Campbell
L J
LJ
Academic Department of HIV/GU Medicine, King's College London, London, France.
Ibrahim
F
F
Fisher
M
M
Holt
S G
SG
Hendry
B M
BM
Post
F A
FA
D016263:AIDS-Associated Nephropathy / Q000139:chemically induced* / Q000453:epidemiology / Q000208:ethnology; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives*; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D015497:HIV-1; D006801:Humans; D019469:Indinavir / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000453:epidemiology / Q000208:ethnology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects*; D015995:Prevalence; D000068698:Tenofovir; D006113:United Kingdom / Q000453:epidemiology
D019380:Anti-HIV Agents; D063065:Organophosphonates; D019469:Indinavir; D000068698:Tenofovir; D000225:Adenine