title: Deteriorating renal function and clinical outcomes in HIV-positive persons.
abstract: OBJECTIVE
  To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality.
  
  
  METHODS
  An observational, longitudinal cohort study of 12 155 persons from EuroSIDA.
  
  
  METHODS
  Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events.
  
  
  RESULTS
  During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24).
  
  
  CONCLUSIONS
  Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.
authors.affiliation: aDepartment of Infection and Population Health, University College London, London, UK bCopenhagen HIV Program cDepartment of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark dUniversity Hospital of Infectious Diseases, Zagreb, Croatia eDepartment of Health Sciences, Institute of Infectious Diseases, Milan, Italy fBelarus State Medical University, Minsk, Belarus gHospital Clinic i Provincial, Barcelona, Spain hInstitute of Tropical Medicine, Antwerp, Belgium iUllevål University Hospital, Ullevål, Norway. *Study group listed in appendix.
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Lene
authors.initials: L
authors.lastname: Ryom
authors.forename: Josip
authors.initials: J
authors.lastname: Begovac
authors.forename: Antonella D'Arminio
authors.initials: AD
authors.lastname: Monforte
authors.forename: Anne
authors.initials: A
authors.lastname: Vassilenko
authors.forename: Jose
authors.initials: J
authors.lastname: Gatell
authors.forename: Eric
authors.initials: E
authors.lastname: Florence
authors.forename: Vidar
authors.initials: V
authors.lastname: Ormaasen
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis