title: Incidence of stage 3 chronic kidney disease and progression on tenofovir-based regimens.
abstract: To describe the incidence of rapid kidney function decline (RKFD), and stage 3 chronic kidney disease (CKD) in HIV-1-infected adults initiated on tenofovir-containing antiretroviral therapy.
  
  
  
  A retrospective cohort study at the infectious diseases clinic of Tygerberg Academic Hospital in Cape Town, South Africa. Patients with more than 3 ml/min per year decline in estimated glomerular filtration were classified as having RKFD, and stage 3 CKD was defined as a value less than 60 ml/min per 1.73 m. We used logistic and Cox proportional hazards regression models to determine factors associated with RKFD and stage 3 CKD.
  
  
  
  Of 650 patients, 361 (55%) experienced RKFD and 15 (2%) developed stage 3 CKD during a median interquartile range follow-up time of 54 (46.6-98) weeks. For every 10-year increase in age and 10 ml/min lower baseline estimated glomerular filtration, the odds of RKFD increased by 70% [adjusted odds ratio = 1.70, 95% confidence interval (CI) 1.36-2.13] and 57% (adjusted odds ratio = 1.57, 95% CI 1.38-1.80), respectively. Each 10-year older age was associated with a 1.90-fold increased risk of developing stage 3 CKD (adjusted hazard ratio = 1.90, 95% CI: 1.10-3.29). Women had about four-fold greater risk of stage 3 CKD compared with men (adjusted hazard ratio = 3.96, 95% CI: 1.06-14.74).
  
  
  
  About half of our study population developed RKFD but only 2% progressed to stage 3 CKD. Approaches that provide balanced allocation of limited resources toward screening and monitoring for kidney dysfunction and HIV disease management are critically needed in this setting.
authors.affiliation: aDepartment of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA bBiostatistics Unit, Stellenbosch University, Cape Town, South Africa cDepartment of Medicine, Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA dDepartment of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences eCentre for Evidence-Based Healthcare; Stellenbosch University, Cape Town, South Africa fDivision of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, UK gDepartment of Medicine, Division of Nephrology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa hDepartments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania iDepartments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Hadas
authors.initials: H
authors.lastname: Zachor
authors.forename: Rhoderick
authors.initials: R
authors.lastname: Machekano
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Veldkamp
authors.forename: Michele D
authors.initials: MD
authors.lastname: Zeier
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.forename: Jantjie J
authors.initials: JJ
authors.lastname: Taljaard
authors.forename: Mohammed R
authors.initials: MR
authors.lastname: Moosa
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D000068698:Tenofovir / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir
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