title: End-stage renal disease among HIV-infected adults in North America.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected adults, particularly those of black race, are at high-risk for end-stage renal disease (ESRD), but contributing factors are evolving. We hypothesized that improvements in HIV treatment have led to declines in risk of ESRD, particularly among HIV-infected blacks.
  
  
  METHODS
  Using data from the North American AIDS Cohort Collaboration for Research and Design from January 2000 to December 2009, we validated 286 incident ESRD cases using abstracted medical evidence of dialysis (lasting >6 months) or renal transplant. A total of 38 354 HIV-infected adults aged 18-80 years contributed 159 825 person-years (PYs). Age- and sex-standardized incidence ratios (SIRs) were estimated by race. Poisson regression was used to identify predictors of ESRD.
  
  
  RESULTS
  HIV-infected ESRD cases were more likely to be of black race, have diabetes mellitus or hypertension, inject drugs, and/or have a prior AIDS-defining illness. The overall SIR was 3.2 (95% confidence interval [CI], 2.8-3.6) but was significantly higher among black patients (4.5 [95% CI, 3.9-5.2]). ESRD incidence declined from 532 to 303 per 100 000 PYs and 138 to 34 per 100 000 PYs over the time period for blacks and nonblacks, respectively, coincident with notable increases in both the prevalence of viral suppression and the prevalence of ESRD risk factors including diabetes mellitus, hypertension, and hepatitis C virus coinfection.
  
  
  CONCLUSIONS
  The risk of ESRD remains high among HIV-infected individuals in care but is declining with improvements in virologic suppression. HIV-infected black persons continue to comprise the majority of cases, as a result of higher viral loads, comorbidities, and genetic susceptibility.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Yuezhou
authors.initials: Y
authors.lastname: Jing
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.affiliation: University of Washington, Seattle.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.affiliation: University of Washington, Seattle.
authors.forename: Heidi
authors.initials: H
authors.lastname: Crane
authors.affiliation: University of North Carolina, Chapel Hill.
authors.forename: Joseph
authors.initials: J
authors.lastname: Eron
authors.affiliation: University of Calgary, Alberta, Canada.
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.affiliation: Mid-Atlantic Kaiser Permanente Research Institute, Rockville, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.affiliation: Veterans Affairs Healthcare System, West Haven, Connecticut Yale University, New Haven, Connecticut;
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Klein
authors.affiliation: Universidad Central del Caribe, Bayamon, Puerto Rico.
authors.forename: Angel M
authors.initials: AM
authors.lastname: Mayor
authors.affiliation: Johns Hopkins Bloomberg School of Public Health Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Yale University, New Haven, Connecticut;
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.affiliation: Kaiser Permanente Northern California, Oakland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.affiliation: University of North Carolina, Chapel Hill.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult
keywords: HIV infection/AIDS; HIV/AIDS; chronic kidney disease (CKD); end-stage renal disease (ESRD); glomerular filtration rate (GFR)