title: Diminished impact of ethnicity as a risk factor for chronic kidney disease in the current HIV treatment era.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is an important comorbidity during human immunodeficiency virus (HIV) infection. Historically, HIV-associated nephropathy has been the predominant cause of CKD and has primarily been observed in people of African ancestry. This study aims to investigate the role of ethnicity in relation to CKD risk in recent years.
  
  
  METHODS
  Analyses were performed including 16 836 patients from the Dutch AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort. Baseline was defined as the first available creatinine level measurement after 1 January 2007; CKD was defined as a glomerular filtration rate of <60 mL/min/1.73 m(2). The associations between ethnicity and both prevalent CKD at baseline and incident CKD during follow-up were analyzed.
  
  
  RESULTS
  The prevalence of baseline CKD was 2.7% (460 of 16 836 patients). Birth in a sub-Saharan African country (hereafter, "SSA origin") was significantly associated with baseline CKD (adjusted odds ratio 1.49; 95% confidence interval [CI], 1.04-2.13). During follow-up (median duration, 4.7 years; interquartile range, 2.4-5.2), the rate of incident CKD was 6.0 events per 1000 person-years. The risk of newly developing CKD was similar between patients of SSA origin and those born in Western Europe, Australia, or New Zealand (adjusted hazard ratio, 1.00; 95% CI, .63-1.59).
  
  
  CONCLUSIONS
  Among HIV-infected patients in the Netherlands, being of SSA origin was associated with a higher baseline CKD prevalence but had no impact on newly developing CKD over time. This suggests a shift in the etiology of CKD from HIV-associated nephropathy toward other etiologies.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht.
authors.forename: Annelot F
authors.initials: AF
authors.lastname: Schoffelen
authors.affiliation: Stichting HIV Monitoring.
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht Department of Internal Medicine, Kennemer Gasthuis, Haarlem.
authors.forename: Steven F L
authors.initials: SF
authors.lastname: van Lelyveld
authors.affiliation: Department of Nephrology.
authors.forename: Liffert
authors.initials: L
authors.lastname: Vogt
authors.affiliation: Department of Infectious Diseases, Centre for Infectious Diseases, Leiden University Medical Centre, The Netherlands.
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Bauer
authors.affiliation: Stichting HIV Monitoring Department of Global Health Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam Amsterdam Institute for Global Health and Development.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht.
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht.
authors.forename: Roos E
authors.initials: RE
authors.lastname: Barth
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000208:ethnology* / Q000821:virology; D012307:Risk Factors; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine
keywords: HIV; chronic kidney disease; estimated glomerular filtration rate; ethnicity; genetic predisposition; renal function; sub-Saharan African origin