Risk factors for ESRD in HIV-infected individuals: traditional and HIV-related factors.
BACKGROUND
Despite improvements in survival with human immunodeficiency virus (HIV) infection, kidney disease remains an important complication. Few studies have evaluated risk factors associated with the development of end-stage renal disease (ESRD) in HIV-infected individuals. We sought to identify traditional and HIV-related risk factors for ESRD in HIV-infected individuals and compare ESRD risk by estimated glomerular filtration rate (eGFR) and proteinuria levels.


METHODS
Retrospective cohort study.


METHODS
22,156 HIV-infected veterans without pre-existing ESRD receiving health care in the Veterans' Affairs medical system between 1996 and 2004.


METHODS
Hypertension, diabetes, cardiovascular disease, hypoalbuminemia (serum albumin <3.5 mg/dL), CD4 lymphocyte count, HIV viral load, hepatitis C virus coinfection, proteinuria, and eGFR were identified using the Veterans' Affairs electronic record system.


RESULTS
ESRD was ascertained by the US Renal Data System.


RESULTS
366 cases of ESRD occurred, corresponding to 3 cases/1,000 person-years. Hypertension (HR, 1.9; 95% CI, 1.5-2.4), diabetes (HR, 1.7; 95% CI, 1.3-2.2), and cardiovascular disease (HR, 2.2; 95% CI, 1.7-2.7) were associated independently with ESRD risk in multivariate-adjusted models, as were CD4 lymphocyte count <200 cells/μL (HR, 1.5; 95% CI, 1.2-2.0), HIV viral load ≥30,000 copies/mL (HR, 2.0; 95% CI, 1.5-2.8), hepatitis C virus coinfection (HR, 1.9; 95% CI, 1.5-2.4), and hypoalbuminemia (HR, 2.1; 95% CI, 1.8-2.5). Compared with persons without chronic kidney disease, defined as eGFR >60 mL/min/1.73 m(2) and no proteinuria, lower eGFR and higher proteinuria categories were associated jointly with exponentially higher ESRD rates, ranging from 6.6 events/1,000 person-years for persons with urine protein excretion of 30-100 mg/dL and eGFR >60 mL/min/1.73 m(2) to 193 events/1,000 person-years for persons with urine protein excretion ≥300 mg/dL and eGFR <30 mL/min/1.73 m(2).


CONCLUSIONS
Results may not be generalizable to female and nonveteran populations.


CONCLUSIONS
In HIV-infected persons, ESRD risk appears attributable to a combination of traditional and HIV-related risk factors for kidney disease. Combining eGFR and proteinuria for chronic kidney disease staging is most effective for stratifying the risk of ESRD.
Division of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA 94121, USA.
Vasantha
V
Jotwani
Yongmei
Y
Li
Carl
C
Grunfeld
Andy I
AI
Choi
Michael G
MG
Shlipak
D000328:Adult; D044383:Black People; D002908:Chronic Disease; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications* / Q000208:ethnology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D015658:HIV Infections / Q000150:complications* / Q000208:ethnology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000150:complications* / Q000208:ethnology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D044465:White People