title: Acute kidney injury among HIV-infected patients admitted to the intensive care unit.
abstract: We describe the incidence, associations and outcomes of acute kidney injury (AKI) among HIV-infected patients admitted to the intensive care unit (ICU). We retrospectively analysed 223 admissions to an inner-London, University-affiliated ICU between 1999 and 2012, and identified those with AKI and performed multivariate analysis to determine associations with AKI. Of all admissions, 66% were affected by AKI of any severity and 35% developed stage 3 AKI. In multivariate analysis, AKI was associated with chronic kidney disease (odds ratio [OR] = 3.19; p = 0.014), a previous AIDS-defining illness (OR = 1.93; p = 0.039) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score, (OR = 3.49; p = 0.018, if > 30). No associations were demonstrated with use of anti-retroviral medication (including tenofovir), or an individual's HIV viral load or CD4 count. AKI was associated with higher inpatient mortality and longer duration of ICU admission. Among patients with stage 3 AKI, only 41% were alive 90 days after ICU admission. Among survivors, 74% regained good renal function, the remainder were dependent on renal replacement therapy or were left with significant ongoing renal dysfunction. Of note, many patients had baseline serum creatinine concentrations well below published reference ranges. AKI among HIV-infected patients admitted to ICU carries a poor prognosis.
authors.affiliation: T8, University College Hospitals London NHS Foundation Trust, London UK.
authors.forename: D W
authors.initials: DW
authors.lastname: Randall
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Brima
authors.affiliation: Critical Care Unit, University College Hospitals London NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Walker
authors.affiliation: Centre for Nephrology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Connolly
authors.affiliation: Centre for Nephrology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Laing
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Copas
authors.affiliation: T8, University College Hospitals London NHS Foundation Trust, London UK Camden Provider Services, Central & North West London NHS Foundation Trust, London, UK.
authors.forename: S G
authors.initials: SG
authors.lastname: Edwards
authors.affiliation: Critical Care Unit, University College Hospitals London NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Batson
authors.affiliation: T8, University College Hospitals London NHS Foundation Trust, London UK Research Department of Infection and Population Health, University College London, London, UK Camden Provider Services, Central & North West London NHS Foundation Trust, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK robert.miller@ucl.ac.uk.
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: AIDS; Acute kidney injury; HIV; antiretroviral therapy; intensive care; outcome; renal dysfunction