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Kidney in HIV+ .......HIV viremia and changes in kidney function
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"Clinicians will need to counsel patients on the risk of kidney disease with long-term therapy......healthcare providers should minimize the morbidity and mortality associated with CKD by implementing routine CKD screening, aggressively managing comorbid conditions, and among persons with CKD, avoiding nephrotoxic agents and referring early to a nephrologist"
from Jules: We need studies to follow HIV+ as they age specifically to see when they reach over 60 years old how kidney function & kidney disease act, what is the actual clinical outcome, what are the risk factors, can we intervene to prevent serious kidney decline, but even in HIV-neg kidney function declines with age.......http://www.natap.org/2008/HIV/092708_03.htm........
Prevalence of Chronic Kidney Disease Among HIV-infected Adults in Care in the United States Medical Monitoring Project, 2009.......Approximately 1 in 13 HIV-infected adults in care in the U.S. has CKD. While the absolute burden of CKD falls predominantly among those aged ≥60 years, younger HIV-infected adults are substantially more likely to have CKD than the general U.S. population. As the HIV- infected population ages, healthcare providers should minimize the morbidity and mortality associated with CKD by implementing routine CKD screening, aggressively managing comorbid conditions, and among persons with CKD, avoiding nephrotoxic agents and referring early to a nephrologist......http://www.natap.org/2013/CROI/croi_146.htm
Chronic kidney disease in HIV infection: an urban epidemic.....http://www.natap.org/2007/HIV/092607_06.htm
Kidney Disease in Patients with HIV Infection and AIDS........http://www.natap.org/2009/HIV/030209_01.htm
Chronic Kidney Disease Prevalence Higher in the USA: related to hypertension, diabetes, aging......http://www.natap.org/2008/HIV/092708_03.htm ......"In CKD stage 3, 11.6% (SE, 2.0%) of men and only 5.5% (SE, 0.8%) of women reported being aware of having weak or failing kidneys....Awareness of CKD remains very low, even among individuals with both reduced kidney function and albuminuria....the prevalence rate of CKD increased from 10.0% to 13.1%. This increase was only slightly explained by the aging of the US population
Improvement of kidney function after anti
HCV therapy in hepatitis C/HIV coinfection.......http://www.natap.org/2014/IAC/IAC_70.htm........After therapy, GFR improved significantly after 24 months (p=0.02). ......At baseline, mean serum creatinine was 0.91 mg/dl (0.6-1.45), and GFR was 90.3 ml/min/1.73m2 (45.4-150.4), with 46% of patients below 90 ml/min. There were higher GFR values in patients without tenofovir (99.6 vs 88.2 ml/min; p=0.009) and with fibrosis 1 vs cirrhotic patients (94.2 vs 88.8; p=0.01).
"Age, hypertension, and diabetes are the key predictors of new onset chronic kidney disease. The main risk associated with chronic kidney disease is of increased cardiovascular events, leading to increased morbidity and mortality. Other important outcomes include acute kidney injury, infection, cognitive impairment, impaired physical function, and progression of kidney disease.".......http://www.natap.org/2012/HIV/100512_02.htm
"Additional studies are needed to identify HIV-infected persons who may be susceptible to declines in kidney function as a result of ART and to determine whether declines in kidney function are related to complications of treatment, such as diabetes or hypertension, or nephrotoxicity associated with the drugs themselves. This information will be relevant to clinical practice, as today most HIV-infected patients receive or will receive ART and lifetime exposure to ART may increase with earlier initiation of therapy [25,26]. Clinicians will need to counsel patients on the risk of kidney disease with long-term therapy."......http://www.natap.org/2009/HIV/052109_05.htm........"In this nationally representative sample of HIV-infected persons, we found that HIV-infected participants were more likely than HIV-negative controls to have clinically significant decline in kidney function and to progress to CKD prospectively after 5 years of follow-up. However, we also found that 26% of HIV-infected persons manifested clinically significant improvements in kidney function. Changes in HIV viral load were strongly associated with both improvements and declines in kidney function that were observed in HIV-infected participants. Our results suggest that HIV viral replication is a primary pathogenic factor in the development of kidney disease in HIV-infected persons and a potential therapeutic target for HIV-related kidney disease."
Interrupted Antiretrovirals Raise Chronic Kidney Disease Risk 50% in SMART.......http://www.natap.org/2011/CROI/croi_34.htm
Metabolic Syndrome and the Risk for Chronic Kidney Disease among Nondiabetic Adults.......http://www.natap.org/2008/HIV/052108_02.htm
from Jules: We need studies to follow HIV+ as they age specifically to see when they reach over 60 years old how kidney function & kidney disease act, what is the actual clinical outcome, what are the risk factors, can we intervene to prevent serious kidney decline, but even in HIV-neg kidney function declines with age.......http://www.natap.org/2008/HIV/092708_03.htm........
Prevalence of Chronic Kidney Disease Among HIV-infected Adults in Care in the United States Medical Monitoring Project, 2009.......Approximately 1 in 13 HIV-infected adults in care in the U.S. has CKD. While the absolute burden of CKD falls predominantly among those aged ≥60 years, younger HIV-infected adults are substantially more likely to have CKD than the general U.S. population. As the HIV- infected population ages, healthcare providers should minimize the morbidity and mortality associated with CKD by implementing routine CKD screening, aggressively managing comorbid conditions, and among persons with CKD, avoiding nephrotoxic agents and referring early to a nephrologist......http://www.natap.org/2013/CROI/croi_146.htm
Chronic kidney disease in HIV infection: an urban epidemic.....http://www.natap.org/2007/HIV/092607_06.htm
Kidney Disease in Patients with HIV Infection and AIDS........http://www.natap.org/2009/HIV/030209_01.htm
Chronic Kidney Disease Prevalence Higher in the USA: related to hypertension, diabetes, aging......http://www.natap.org/2008/HIV/092708_03.htm ......"In CKD stage 3, 11.6% (SE, 2.0%) of men and only 5.5% (SE, 0.8%) of women reported being aware of having weak or failing kidneys....Awareness of CKD remains very low, even among individuals with both reduced kidney function and albuminuria....the prevalence rate of CKD increased from 10.0% to 13.1%. This increase was only slightly explained by the aging of the US population
Improvement of kidney function after anti
HCV therapy in hepatitis C/HIV coinfection.......http://www.natap.org/2014/IAC/IAC_70.htm........After therapy, GFR improved significantly after 24 months (p=0.02). ......At baseline, mean serum creatinine was 0.91 mg/dl (0.6-1.45), and GFR was 90.3 ml/min/1.73m2 (45.4-150.4), with 46% of patients below 90 ml/min. There were higher GFR values in patients without tenofovir (99.6 vs 88.2 ml/min; p=0.009) and with fibrosis 1 vs cirrhotic patients (94.2 vs 88.8; p=0.01).
"Age, hypertension, and diabetes are the key predictors of new onset chronic kidney disease. The main risk associated with chronic kidney disease is of increased cardiovascular events, leading to increased morbidity and mortality. Other important outcomes include acute kidney injury, infection, cognitive impairment, impaired physical function, and progression of kidney disease.".......http://www.natap.org/2012/HIV/100512_02.htm
"Additional studies are needed to identify HIV-infected persons who may be susceptible to declines in kidney function as a result of ART and to determine whether declines in kidney function are related to complications of treatment, such as diabetes or hypertension, or nephrotoxicity associated with the drugs themselves. This information will be relevant to clinical practice, as today most HIV-infected patients receive or will receive ART and lifetime exposure to ART may increase with earlier initiation of therapy [25,26]. Clinicians will need to counsel patients on the risk of kidney disease with long-term therapy."......http://www.natap.org/2009/HIV/052109_05.htm........"In this nationally representative sample of HIV-infected persons, we found that HIV-infected participants were more likely than HIV-negative controls to have clinically significant decline in kidney function and to progress to CKD prospectively after 5 years of follow-up. However, we also found that 26% of HIV-infected persons manifested clinically significant improvements in kidney function. Changes in HIV viral load were strongly associated with both improvements and declines in kidney function that were observed in HIV-infected participants. Our results suggest that HIV viral replication is a primary pathogenic factor in the development of kidney disease in HIV-infected persons and a potential therapeutic target for HIV-related kidney disease."
Interrupted Antiretrovirals Raise Chronic Kidney Disease Risk 50% in SMART.......http://www.natap.org/2011/CROI/croi_34.htm
Metabolic Syndrome and the Risk for Chronic Kidney Disease among Nondiabetic Adults.......http://www.natap.org/2008/HIV/052108_02.htm
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