title: Baseline kidney function as predictor of mortality and kidney disease progression in HIV-positive patients.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is associated with increased all-cause mortality and kidney disease progression. Decreased kidney function at baseline may identify human immunodeficiency virus (HIV)-positive patients at increased risk of death and kidney disease progression.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  7 large HIV cohorts in the United Kingdom with kidney function data available for 20,132 patients.
  
  
  METHODS
  Baseline estimated glomerular filtration rate (eGFR).
  
  
  RESULTS
  Death and progression to stages 4-5 CKD (eGFR <30 mL/min/1.73 m(2) for >3 months) in Cox proportional hazards and competing-risk regression models.
  
  
  RESULTS
  Median age at baseline was 34 (25th-75th percentile, 30-40) years, median CD4 cell count was 350 (25th-75th percentile, 208-520) cells/μL, and median eGFR was 100 (25th-75th percentile, 87-112) mL/min/1.73 m(2). Patients were followed up for a median of 5.3 (25th-75th percentile, 2.0-8.9) years, during which 1,820 died and 56 progressed to stages 4-5 CKD. A U-shaped relationship between baseline eGFR and mortality was observed. After adjustment for potential confounders, eGFRs <45 and >105 mL/min/1.73 m(2) remained associated significantly with increased risk of death. Baseline eGFR <90 mL/min/1.73 m(2) was associated with increased risk of kidney disease progression, with the highest incidence rates of stages 4-5 CKD (>3 events/100 person-years) observed in black patients with eGFR of 30-59 mL/min/1.73 m(2) and those of white/other ethnicity with eGFR of 30-44 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  The relatively small numbers of patients with decreased eGFR at baseline and low rates of progression to stages 4-5 CKD and lack of data for diabetes, hypertension, and proteinuria.
  
  
  CONCLUSIONS
  Although stages 4-5 CKD were uncommon in this cohort, baseline eGFR allowed the identification of patients at increased risk of death and at greatest risk of kidney disease progression.
authors.affiliation: King's College London, United Kingdom.
authors.forename: Fowzia
authors.initials: F
authors.lastname: Ibrahim
authors.forename: Lisa
authors.initials: L
authors.lastname: Hamzah
authors.forename: Rachael
authors.initials: R
authors.lastname: Jones
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Frank A
authors.initials: FA
authors.lastname: Post
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000401:mortality* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology*; D055815:Young Adult