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Prevalence and Prognostic Factors of Chronic Kidney Disease in HIV-infected Patients, HIV-NAT 006 Cohort, Thailand: "high prevalence of advanced chronic kidney disease...more diabetes/hypertension" - pdf attached
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Download the PDF here
Reported by Jules Levin
CROI 2011 March 2 Boston
Anchalee Avihingsanon*1,2, K Praditpornsilpa1, J Wongsabut2, A Clark2,3, S Kerr2,3, S Ubolyam2, P Phanuphak2, J Ananworanich1,2,4, N Hiransuthikul1, K Ruxrungtham1,2, and HIVNAT 006 Study Team
1Faculty of Med, Chulalongkorn Univ, Thailand; 2HIVNAT Res Collaboration, Thai Red Cross AIDS Res Ctr, Bangkok; 3Natl Ctr in HIV Epi and Clin Res, Univ of New South Wales, Sydney, Australia; and 4South East Asia Res Collaboration with Hawaii, Bangkok, Thailand
Background: Chronic kidney disease (CKD) is a major public health problem worldwide and it is associated with cardiovascular complications. The prevalence and predictors of CKD in HIV-infected Asians have not been well defined.
Methods: We assessed CKD in 1317 HIV-infected Thais at HIV-NAT in Bangkok. Estimated glomerular filtration rate (eGFR) was calculated using the simplified modification of diet in renal disease equation (MDRD) and CKD was staged according to accepted NIH/NIDDK Kidney Disease Outcomes Quality Initiative standards. Patients were divided into 3 groups based on eGFR; normal (>90 without hematuria/proteinuria), mild CKD (60 to 89), and advanced CKD (<60 regardless of hematuria/proteinuria). Factors associated with the development of CKD were determined by Cox proportional hazards regression using a forward-stepwise approach.
Results: Forty-five percent of subjects were female with median age 35 (IQR 30 to 40) years. Most recent median BW was 57.6 (57 to 65) kg and median CD4 was 522 (378 to 706) cells/μL. Forty percent had baseline CD4 <200 cells/μL. Median time on ART was 8.1 (4.7 to 10.2) years. Three hundred and three (23%) patients had indinavir (IDV) exposure. Median baseline GFR was 88 (IQR 77 to 100), none had GFR < 70 mL/min/1.73m2 prior to taking antiretrovirals (ARV). Overall CKD prevalence was 62% with 32% mild and 30% advanced CKD (GFR 30 to 59: 26%, 15 to 29: 2.8%, <15: 1%). The incidence of advanced CKD for the whole cohort and tenofovir (TDF) user were 4.8 per 100 person-years and 5.5 per 100 person-years, respectively. Compared to the normal eGFR group, the advanced CKD group was significantly older (37 vs 32 years), with fewer females (39% vs 48%), lower baseline eGFR (78 vs 101 mL/min/1.73m2), more IDV exposure (46% vs 16%), longer ARV duration (9.9 vs 6.9 years), more hypertension (HT) (19% vs 8%), and more diabetes mellitus (DM) (13% vs 5%). Overall, 846 patients were on TDF; 120 (14%) and 18 (2%) needed TDF dose reduction or discontinuation, respectively. In multivariate analysis, advanced CKD was associated with age >50 years (HR 2.1; 95%CI 1.5 to 3.0), IDV exposure (HR 3.1; 95%CI 2.5 to 3.8), DM (HR 1.8; 95%CI 1.3 to 2.4), and TDF exposure (HR 1.6; 95%CI 1.2 to 2.3).
Conclusions: Our cohort revealed a high prevalence of advanced CKD among HIV-infected Thais, particularly those with older age, DM, and exposure to IDV or TDF. Close monitoring of renal function is warranted among Asian patients with these risk factors, especially when potentially nephrotoxic ARV are used.
RESULTS
1317 (45% female) patients were enrolled into the study; 40% had baseline CD4 <200 cells/μL. Patient characteristics are shown
in Table 1
Median age at start of entry to study was 35 (IQR 30 - 40) years
Median time on ART was 8.1 (4.7 - 10.2) years, and 303 (23%) patients had been exposed to indinavir (IDV)
Most recent median body weight was 57.6 (57-65) kg and most recent median CD4 was 522 (378-706) cells/μL, and 87% HIV
RNA undetectable at most recent test
Median baseline GFR was 88 (IQR 77-100), none had GFR < 60 ml/min/1.73m2 prior to taking ARV.
Overall CKD prevalence was 69% (39% mild and 30% advanced CKD [GFR 30-59: 26%, 15-29: 2.8%, <15: 1%]).
The incidence of advanced CKD for the whole cohort and TDF user were 4.8 per 100 person-years and 5.5 per 100 person-years,
respectively.
846 patients were taking tenofovir (TDF). 120 (14%) and 18 (2%) needed TDF dose reduction or discontinuation, respectively.
In Figure 2, in multivariate analysis, advanced CKD was associated with age >50 years [Hazard ratio (HR) 2.1; 95%CI 1.5-3.0],
IDV exposure (HR 3.1; 95%CI 2.5-3.8), Diabetes mellitus [DM] (HR1.8; 95%CI 1.3-2.4), and TDF exposure (HR1.6; 95%CI
Note the high rates of diabetes, hypertension, proteinuria, metabolic syndrome & lipodystrophy in patients with CKD stage III-V GFR <60 !!
References
1. George E. Kidney function and the risk of cardiovascular events in HIV-1-infected patients. AIDS 2010;24(3):387-94.
2. Levey AS. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). 2005; 67(6):2089-100.
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