title: Continuous Ambulatory Peritoneal Dialysis in Patients with HIV and End-Stage Renal Failure.
abstract: ♦ BACKGROUND: This study aimed to evaluate the differences in continuous ambulatory peritoneal dialysis (CAPD)-related outcomes according to human immunodeficiency virus (HIV) status of end-stage renal failure patients. ♦ METHODS: This prospective cohort study included 70 HIV-negative and 70 HIV-positive consecutive patients with renal failure who underwent dialysis with newly inserted Tenckhoff catheters between September 2012 and February 2015. Patients were followed up monthly at a central renal clinic for 1 year or until the primary endpoints of technique failure or death. ♦ RESULTS: Technique failure rates were similar (HIV-negative: 0.270 episodes/person-year; HIV-positive: 0.298 episodes/person-year; hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.51 - 2.32;p= 0.822). However, there were fewer HIV-positive patients with complete 1-year follow-up with a patent catheter (42.9% vs 58.6% in the HIV-negative cohort;p= 0.063) owing to their higher all-cause mortality rate (0.55 vs 0.25 deaths/person-year, respectively; HR, 2.11; CI, 1.07 - 4.14;p= 0.031). Cluster of differentiation 4 count (CD4) < 200/μL (HR, 5.39; CI, 2.20 - 13.21;p< 0.001) and unsuppressed viral load (HR, 3.63; CI 1.72 - 7.67;p= 0.001) were associated with increased mortality hazards. Rates of first peritonitis were 0.616 (HIV-negative) and 1.668 (HIV-positive) episodes/person-year (HR, 2.38; CI, 1.46 - 3.89;p= 0.001). All-cause admission rates were 1.52 (HIV-negative) and 2.97 (HIV-positive) hospital admissions/person-year (HR, 1.66; CI, 1.12 - 2.48;p= 0.013). ♦ CONCLUSION: Although HIV-seropositive status of patients on CAPD did not adversely influence technique failure rates or patency at 1 year, uncontrolled HIV infection may be associated with increased relative risk of mortality and morbidity.
authors.affiliation: Inkosi Albert Luthuli Central Hospital, Durban, South Africa kczndlovu@gmail.com ndlovuk@ukzn.ac.za.|Department of Nephrology, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Kwazi C Z
authors.initials: KCZ
authors.lastname: Ndlovu
authors.affiliation: Inkosi Albert Luthuli Central Hospital, Durban, South Africa.|Department of Nephrology, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Alain
authors.initials: A
authors.lastname: Assounga
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010343:Patient Admission / Q000639:trends; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D055815:Young Adult
keywords: CAPD; Continuous ambulatory peritoneal dialysis; HIV; catheter patency; first peritonitis; hospital admission; morbidity; mortality; technique failure