title: Comorbid diabetes and the risk of progressive chronic kidney disease in HIV-infected adults: data from the Veterans Aging Cohort Study.
abstract: BACKGROUND
  Approximately, 15% of HIV-infected individuals have comorbid diabetes. Studies suggest that HIV and diabetes have an additive effect on chronic kidney disease (CKD) progression; however, this observation may be confounded by differences in traditional CKD risk factors.
  
  
  METHODS
  We studied a national cohort of HIV-infected and matched HIV-uninfected individuals who received care through the Veterans Healthcare Administration. Subjects were divided into 4 groups based on baseline HIV and diabetes status, and the rate of progression to an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73m was compared using Cox-proportional hazards modeling to adjust for CKD risk factors.
  
  
  RESULTS
  About 31,072 veterans with baseline eGFR ≥45 mL/min/1.73m (10,626 with HIV only, 5088 with diabetes only, and 1796 with both) were followed for a median of 5 years. Mean baseline eGFR was 94 mL/min/1.73m, and 7% progressed to an eGFR < 45 mL/min/1.73m. Compared with those without HIV or diabetes, the relative rate of progression was increased in individuals with diabetes only [adjusted hazard ratio (HR) 2.48; 95% confidence interval (CI): 2.19 to 2.80], HIV only [HR: 2.80, 95% CI: 2.50 to 3.15], and both HIV and diabetes [HR: 4.47, 95% CI: 3.87 to 5.17].
  
  
  CONCLUSIONS
  Compared with patients with only HIV or diabetes, patients with both diagnoses are at significantly increased risk of progressive CKD even after adjusting for traditional CKD risk factors. Future studies should evaluate the relative contribution of complex comorbidities and accompanying polypharmacy to the risk of CKD in HIV-infected individuals and prospectively investigate the use of cART, glycemic control, and adjunctive therapy to delay CKD progression.
authors.affiliation: Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Medapalli
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Kirsha
authors.initials: K
authors.lastname: Gordon
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: John Cijiang
authors.initials: JC
authors.lastname: He
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wyatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D018570:Risk Assessment; D014728:Veterans; D055815:Young Adult