Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.
With the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR) and associated risk factors in a cohort of HIV-infected patients from a middle-income country. Our cross-sectional study included all adult patients who attended an urban outpatient clinic in 2008. GFR was estimated using the CKD-EPI equation. The prevalence ratio (PR) of decreased GFR (defined as <60 mL/min/1.73 m(2)) was estimated using generalizing linear models assuming a Poisson distribution. We analyzed data from 1,970 patients, of which 82.9% had been exposed to ART. A total of 249 patients (12.6%) had a GFR between 60 and 89 mL/min/1.73 m(2), 3.1% had a GFR between 30 and 59, 0.3% had a GFR between 15 and 29, and 0.4% had a GFR <15. Decreased GFR was found in only 74 patients (3.8%). In the multivariate regression model, the factors that were independently associated with a GFR below 60 mL/min/1.73 m(2) were as follows: age ≥ 50 years (PR = 3.4; 95% CI: 1.7-6.8), diabetes (PR = 2.0; 95% CI: 1.2-3.4), hypertension (PR = 2.0; 95% CI: 1.3-3.2), current CD4+ cell count <350 cells/mm3 (PR = 2.1; 95% CI: 1.3-3.3), past exposure to tenofovir (PR = 4.7; 95% CI: 2.3-9.4) and past exposure to indinavir (PR =1.7; 95% CI: 1.0-2.8). As in high-income countries, CKD was the predominant form of kidney involvement among HIV-infected individuals in our setting. The risk factors associated with decreased glomerular filtration were broad and included virus-related factors as well as degenerative and nephrotoxic factors. Despite the potential for nephrotoxicity associated with some antiretroviral drugs, in the short-term, advanced chronic renal disease remains very rare.
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Patrícia
P
Santiago
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Beatriz
B
Grinsztejn
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Ruth Khalili
RK
Friedman
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Cynthia B
CB
Cunha
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Lara Esteves
LE
Coelho
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Paula Mendes
PM
Luz
Department of Pathology, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Albanita Viana
AV
de Oliveira
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Ronaldo Ismério
RI
Moreira
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Sandra W
SW
Cardoso
STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Valdilea G
VG
Veloso
Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
José H Rocco
JH
Suassuna
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors
D019380:Anti-HIV Agents