title: Clinical outcomes of a combined HIV and renal clinic.
abstract: BACKGROUND
  Renal disease is an emerging problem in patients living with human immunodeficiency virus (HIV), as illustrated by an increased incidence of acute kidney injury and chronic kidney disease (CKD) from HIV, its associated treatment and comorbidities such as diabetes and vascular disease. We have established a combined HIV-renal clinic to manage such patients, enhance their treatment and minimize outpatient visits.
  
  
  METHODS
  We have analysed the outcomes of the first 99 patients seen in the clinic using electronic patient records. These ninety-nine patients were referred to the service from HIV physicians in West London and all the patients were seen jointly by an HIV and a renal consultant.
  
  
  RESULTS
  Sixty-five percent of the patients were referred with reduced renal function or proteinuria [mean creatinine at presentation 136 mcmol/L, estimated glomerular filtration rate (eGFR) 57 mL/min/1.73 m(2)]. The majority (53%) had risk factors predisposing to vascular disease including diabetes, hypertension, previous stroke or myocardial infarction. Overall, 27% of patients had a renal diagnosis directly associated with HIV (HIVAN, immune complex nephritis, tenofovir toxicity, Fanconi syndrome), 73% had an alternative possible cause. Twenty-seven percent of patients had low-level proteinuria (urine protein:creatinine ratio abnormal but <100 mg/mmol) or mildly reduced eGFR (40-66 mL/min/1.73 m(2)) without a clear underlying cause. Ten percent of patients were thought to have tenofovir-induced renal damage all of whom improved on cessation of this agent. Following the review in the combined clinic, 64% of patients had a change in treatment or management, with 50% improving their renal parameters as a result. Most patients were discharged back to their main HIV teams for ongoing follow-up.
  
  
  CONCLUSIONS
  A combined HIV-renal clinic can enhance patient care with reduced outpatient visits.
authors.affiliation: Imperial College Renal and Transplant Centre , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: Mark
authors.initials: M
authors.lastname: McClure
authors.affiliation: HIV/GUM Directorate , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.
authors.forename: G Jagjit
authors.initials: GJ
authors.lastname: Singh
authors.affiliation: HIV/GUM Directorate , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Rayment
authors.affiliation: HIV/GUM Directorate , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Jones
authors.affiliation: Imperial College Renal and Transplant Centre , Imperial College Healthcare NHS Trust , London , UK.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Levy
keywords: HIV; chronic kidney disease; proteinuria; tenofovir