title: Clinical evolution of chronic renal patients with HIV infection in replacement therapy.
abstract: Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.
authors.affiliation: Coordinación de Registros, Sociedad Española de Nefrología. Electronic address: rmsaracho@gmail.com.
authors.forename: Ramón
authors.initials: R
authors.lastname: Saracho
authors.affiliation: Organización Nacional de Trasplantes (ONT).
authors.forename: Eduardo
authors.initials: E
authors.lastname: Martín Escobar
authors.affiliation: Registre de Malalts Renals de Catalunya, Organització Catalana de Trasplantaments.
authors.forename: Jordi
authors.initials: J
authors.lastname: Comas Farnés
authors.affiliation: Registre de Malalts Renals de Catalunya, Organització Catalana de Trasplantaments.
authors.forename: Emma
authors.initials: E
authors.lastname: Arcos
authors.affiliation: Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España.
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Mazuecos Blanca
authors.affiliation: Servicio de Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Gentil Govantes
authors.affiliation: Sistema de Información de la Coordinación Autonómica de Trasplantes de Andalucía (SICATA).
authors.forename: Pablo
authors.initials: P
authors.lastname: Castro de la Nuez
authors.affiliation: Registre de Malalts Renals de la Comunidad Valenciana (REMRENAL).
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Zurriaga
authors.affiliation: Registre de Malalts Renals de la Comunidad Valenciana (REMRENAL).
authors.forename: Manuel
authors.initials: M
authors.lastname: Ferrer Alamar
authors.affiliation: Rexistro de Enfermos Renais de Galicia (REXER).
authors.forename: Encarnación
authors.initials: E
authors.lastname: Bouzas Caamaño
authors.affiliation: Rexistro de Enfermos Renais de Galicia (REXER).
authors.forename: Teresa
authors.initials: T
authors.lastname: García Falcón
authors.affiliation: Registro de Enfermos Renales de Madrid-REMER.
authors.forename: José
authors.initials: J
authors.lastname: Portolés Pérez
authors.affiliation: Registro de Enfermos Renales de Madrid-REMER.
authors.forename: José A
authors.initials: JA
authors.lastname: Herrero Calvo
authors.affiliation: Registro de Enfermos Renales de Madrid-REMER.
authors.forename: Carlos
authors.initials: C
authors.lastname: Chamorro Jambrina
authors.affiliation: Unidad de Información de Pacientes Renales, CA País Vasco (UNIPAR).
authors.forename: Íñigo
authors.initials: Í
authors.lastname: Moina Eguren
authors.affiliation: Unidad de Información de Pacientes Renales, CA País Vasco (UNIPAR).
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Rodrigo de Tomás
authors.affiliation: Registro de Enfermos Renales de Aragón.
authors.forename: José María
authors.initials: JM
authors.lastname: Abad Díez
authors.affiliation: Registro de Enfermos Renales de Aragón.
authors.forename: José I
authors.initials: JI
authors.lastname: Sánchez Miret
authors.affiliation: Registro de Enfermos Renales de Aragón.
authors.forename: Rafael
authors.initials: R
authors.lastname: Alvarez Lipe
authors.affiliation: Registro de Enfermos Renales en Tratamiento Sustitutivo de Castilla-La Mancha.
authors.forename: Rafael
authors.initials: R
authors.lastname: Díaz Tejeiro
authors.affiliation: Registro de Enfermos Renales en Tratamiento Sustitutivo de Castilla-La Mancha.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Moreno Alía
authors.affiliation: Registro de Enfermos Renales en Tratamiento Sustitutivo de Castilla-La Mancha.
authors.forename: Marta
authors.initials: M
authors.lastname: Torres Guinea
authors.affiliation: Registro de Enfermos Renales de La Rioja.
authors.forename: Enma
authors.initials: E
authors.lastname: Huarte Loza
authors.affiliation: Registro de Enfermos Renales de La Rioja.
authors.forename: Marta
authors.initials: M
authors.lastname: Artamendi Larrañaga
authors.affiliation: Registro de Diálisis y Trasplante de Castilla y León.
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández Renedo
authors.affiliation: Registro de Diálisis y Trasplante de Castilla y León.
authors.forename: Raquel
authors.initials: R
authors.lastname: González Fernández
authors.affiliation: Registro de Enfermedades Renales Crónicas de Asturias (RERCA).
authors.forename: Emilio
authors.initials: E
authors.lastname: Sánchez Álvarez
authors.affiliation: Registro de Enfermedades Renales Crónicas de Asturias (RERCA).
authors.forename: Ramón
authors.initials: R
authors.lastname: Alonso de la Torre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000150:complications; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D017582:Renal Replacement Therapy; D013030:Spain; D055815:Young Adult
keywords: Chronic kidney disease; Dialysis and transplant registries; Enfermedad renal crónica en tratamiento sustitutivo; Epidemiology; Epidemiología; HIV infection; Infección por VHI; Registros de diálisis y trasplante; Supervivencia; Survival; renal replacement therapy