title: Nephrology consultations incorporated into HIV care - non-compliance is an important issue.
abstract: Although infrequent, kidney disease is a potentially serious co-morbidity among human immunodeficiency virus (HIV)-infected patients. The spectrum of renal impairment is very wide from clinically insignificant to end stage renal disease and often requires nephrologist's consultation. Therefore, we established combined renal and HIV care in the HIV Out-Patient Clinic in Warsaw. Medical records of patients consulted by nephrologist from March 2014 to March 2015 were included in analyses. Patients changing medication without consulting the physician or persistently not coming for follow-up visits were defined as non-compliant. In statistical analyses, non-parametric tests and logistic regression models were used as appropriate. In total, 100 patients were consulted by a nephrologist during the study period. All patients were white Europeans, 88 (88%) male, 42 (42%) infected through men having sex with men and 16 (16%) through intravenous drug users. Fifteen (15%) patients had hepatitis C virus (HCV) infections and 11 (11%) confirmed with positive HCV RNA. The most common reasons for referral were proteinuria and increased serum creatinine. In 6 out of 31 patients (19.3% of those referred for increased creatinine level) elevated serum creatinine was due to illegal substances or diet supplements use. Fifty-seven (57%) of patients were non-compliant. In univariate logistic regression models, all tested factors were non-significant. In most cases, patients were referred to nephrologist due to possible link between laboratory abnormalities and antiretroviral treatment. In one out of five cases, elevated creatinine level was linked with substance/dietary abuse. Poor compliance is an important problem in integrated nephrological care, however we were not able to identify any factors associated with non-compliance.
authors.affiliation: a Hospital for Infectious Diseases , HIV Out-Patient Clinic , Warsaw , Poland.
authors.forename: Bartłomiej
authors.initials: B
authors.lastname: Matłosz
authors.affiliation: a Hospital for Infectious Diseases , HIV Out-Patient Clinic , Warsaw , Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Firląg-Burkacka
authors.affiliation: a Hospital for Infectious Diseases , HIV Out-Patient Clinic , Warsaw , Poland.|b Department for Adults Infectious Diseases , Medical University of Warsaw , Warsaw , Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Horban
authors.affiliation: a Hospital for Infectious Diseases , HIV Out-Patient Clinic , Warsaw , Poland.|b Department for Adults Infectious Diseases , Medical University of Warsaw , Warsaw , Poland.
authors.forename: Justyna D
authors.initials: JD
authors.lastname: Kowalska
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000009:adverse effects; D060085:Coinfection / Q000821:virology; D003404:Creatinine / Q000097:blood; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D000067455:No-Show Patients; D011507:Proteinuria / Q000209:etiology; D012017:Referral and Consultation; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology* / Q000652:urine; D019966:Substance-Related Disorders / Q000150:complications; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D003404:Creatinine
keywords: HIV; Kidney disease; non-compliance