title: Screening and management of renal disease in human immunodeficiency virus-infected patients in Australia.
abstract: BACKGROUND
  Renal disease has become one of the most important comorbidities observed in the human immunodeficiency virus (HIV)-infected patient cohort. Data are lacking on the current screening and management of renal disease in patients with HIV. We evaluated HIV-infected Australian adults in primary care to determine current practices.
  
  
  METHODS
  This prospective, multicentre observational study included two rounds of data collection; the first was followed by an educational programme. Outcomes included screening for renal disease; management of risk factors for kidney disease and other comorbidities associated with renal disease.
  
  
  RESULTS
  Fifty-three general practitioners participated with 733 patients enrolled. Most were male (94%); almost 40% were 41-50 years of age, and 6% and 84% were receiving antiretroviral therapy. Comorbidities were common; 19% had hypertension, 5% were diabetic, 32% were dyslipidaemic, and 40% were smokers. Estimated glomerular filtration rate was commonly measured in both rounds of data collection (96% vs 95%). Proteinuria was assessed less frequently; this improved after education (48% vs 71%). Almost 10% of patients tested had proteinuria on urinalysis. Of the 45 patients (6%) with renal impairment (estimated glomerular filtration rate <60 mL/min), none was referred for assessment by a renal specialist.
  
  
  CONCLUSIONS
  This large observational study provides important information on renal disease in HIV-infected patients, an area with a paucity of clinical data. Current screening and management practices fall short of suggested guidelines. Failure to refer patients to specialists is a major deficiency. Improvements with education suggest the need to promote awareness of guidelines in primary care doctors.
authors.affiliation: Renal Unit, Royal Prince Alfred Hospital, Sydney, New South Wales. david.gracey@sswahs.nsw.gov.au
authors.forename: D
authors.initials: D
authors.lastname: Gracey
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.forename: M
authors.initials: M
authors.lastname: Bailey
authors.forename: D
authors.initials: D
authors.lastname: Richards
authors.forename: B
authors.initials: B
authors.lastname: Dalton
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents