title: Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care.
abstract: OBJECTIVE
  To examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART.
  
  
  METHODS
  Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes.
  
  
  RESULTS
  Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from -2.18 to -1.37 ml/min per 1.73 m per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold <60 ml/min per 1.73 m: 3.35 (95% confidence interval (CI) = 1.40-8.02)], which developed in 5.7% of patients after 4 years of exposure to this regimen-type.
  
  
  CONCLUSIONS
  ART was associated with reduced CKD risk in association with CD4 cell restoration and plasma viral load suppression, despite an increased CKD risk that was associated with initial regimens that included tenofovir and rPI.
authors: Metro Health Medical Center, Cleveland, Ohio, USA.
authors: Robert C
authors: RC
authors: Kalayjian
authors: Bryan
authors: B
authors: Lau
authors: Rhoderick N
authors: RN
authors: Mechekano
authors: Heidi M
authors: HM
authors: Crane
authors: Benigno
authors: B
authors: Rodriguez
authors: Robert A
authors: RA
authors: Salata
authors: Zipporah
authors: Z
authors: Krishnasami
authors: James H
authors: JH
authors: Willig
authors: Jeffrey N
authors: JN
authors: Martin
authors: Richard D
authors: RD
authors: Moore
authors: Joseph J
authors: JJ
authors: Eron
authors: Mari M
authors: MM
authors: Kitahata
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000175:diagnosis* / Q000453:epidemiology; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D019438:Ritonavir / Q000008:administration & dosage; D000068698:Tenofovir; D014481:United States / Q000453:epidemiology; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D003404:Creatinine; D000225:Adenine; D019438:Ritonavir