title: Predictors of advanced chronic kidney disease and end-stage renal disease in HIV-positive persons.
abstract: OBJECTIVE
  Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown.
  
  
  METHODS
  D:A:D participants with at least three estimated glomerular filtration rates (eGFR) after February 2004 were followed until the first of advanced CKD (confirmed eGFR ≤ 30 ml/min, ≥3 months apart), ESRD (dialysis ≥3 months/ transplantation), 6 months after last visit or February 2012.
  
  
  METHODS
  Poisson regression was used to assess risk factors for advanced CKD/ESRD including exposure to potential nephrotoxic antiretroviral drugs and antiretroviral drug discontinuation rates according to latest eGFR.
  
  
  RESULTS
  Among 35 192 persons contributing 200 119 person years of follow-up (PYFU), 135 (0.4%) developed advanced CKD (n = 114)/ESRD (n = 21); incidence rate = 0.67 [95% confidence interval (CI), 0.56-0.79]/1000 PYFU. Tenofovir (TDF) was particularly frequently discontinued as eGFR declined. After adjustment, those previously exposed but currently off TDF had similar advanced CKD/ESRD rate ratios compared with those unexposed [1.00 (95% CI, 0.66-1.51)], while those currently on TDF had reduced rates [0.23 (95% CI, 0.13-0.41)]. No consistent associations with other antiretroviral drugs were seen. Results were robust after time-lagging antiretroviral drug exposure, stratifying by baseline eGFR, and allowing for competing risks. Other predictors were diabetes, hypertension, baseline eGFR, smoking and current CD4 cell count. The incidence rate in nonsmokers with baseline eGFR > 60 and no diabetes or hypertension was 0.16 (95% CI 0.09-0.26)/1000 PYFU.
  
  
  CONCLUSIONS
  Neither current nor recent antiretroviral drug use predicted advanced CKD/ESRD during 6 years median follow-up in a large, heterogenenous and primarily white cohort. TDF discontinuation rates increased with decreasing eGFR, leaving a selected group still on TDF at lower advanced CKD/ESRD risk. Traditional renal risk factors and current CD4 cell count were the strongest advanced CKD/ESRD predictors.
authors.affiliation: aCopenhagen HIV Programme, University of Copenhagen, Faculty of Health and Medical Sciences and Epidemiklinikken M5132, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark bResearch Department of Infection and Population Health, UCL, London, UK cDivision of Nephrology, Mount Sinai School of Medicine, New York, USA dAcademic Medical Center, University of Amsterdam, and Stichting HIV Monitoring, The Netherlands eClinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Switzerland fService de médecine interne et maladies infectieuses, Hôpital Saint-André, CHU de Bordeaux gNephrology Department, Public Health Department, CHU Nice, France hICAP-Columbia University and Harlem Hospital, New York, USA iKirby Institute, Sydney, Australia.
authors.forename: Lene
authors.initials: L
authors.lastname: Ryom
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Michael
authors.initials: M
authors.lastname: Ross
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Christophe A
authors.initials: CA
authors.lastname: Fux
authors.forename: Philippe
authors.initials: P
authors.lastname: Morlat
authors.forename: Olivier
authors.initials: O
authors.lastname: Moranne
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000453:epidemiology*; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents