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"HIV and diabetes may have an additive effect
on CKD risk " - HIV & the Aging Kidney
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"Diabetes and hypertension are the two leading causes, accounting for 64% of prevalent end-stage renal disease (ESRD) cases in the USA [18]. Black race is a strong risk factor for CKD and CKD progression" from Jules: we know hypertension & diabetes are increasingly common in HIV+ as they age.....Hypertension prevalence was higher among HIV-1-infected individuals compared with controls (48.2% vs 36.4%; odds ratio [OR], 1.63. http://www.natap.org/2016/HIV/2016-vanZoest-cid_ciw285.pdf Our findings suggest that changes in body composition, involving both abdominal obesity and stavudine-induced peripheral lipoatrophy http://www.natap.org/2016/HIV/j1468-1293.2009.00720.x1.pdf, might contribute to the higher prevalence of hypertension in HIV-1-infected patients. In a WIHS analysis: 40% of women with HIV and 38% without HIV had hypertension, we know the HIV uninfected control group in WIHS is also a at risk group for health issues. HIV+ are more likely to suffer poor control of hypertension & diabetes http://www.natap.org/2015/IDSA/IDSA_07.htm
The prevalence of CKD also increases dramatically in older adults, affecting more than 60% of United States adults at least 80 years of age [2]. Older adults are at increased risk for CKD as a result of increasing comorbidity and a physiologic decline in GFR with age. On average, individuals over 60 years of age have 20-30% lower GFR than those younger than 50 years [20], consequent to structural and functional changes in the aging kidney that are accelerated in association with comorbidities including hypertension, diabetes, and cardiovascular disease [21].
"Similar to the general population, aging of the HIV-positive population will result in an increase in the incidence of CKD"
HIV and the aging kidney - (06/16/14) Nadkarni, Girish N.a,*; Konstantinidis, Ioannisb,*; Wyatt, Christina M.a
RENAL FAILURE Doubles in HIV from age group 50-60 to >60 - so do hypertension, diabetes & CVD- In Italian study: The prevalence of multi comorbidities among HIV-infected persons was approximately equivalent to prevalence observed in members of the general population who were 10-15 years older....The simultaneous presence of CVD, Htn, DM, renal failure, and bone fracture can reasonably be considered to represent a frailty phenotype that has been associated with aging in the general population and is a major determinant of disability associated with geriatric syndromes.
Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population - (10/21/11)
HIV infection may accelerate the course of kidney disease associated with traditional risk factors, such as diabetes, which are more common in older adults. The risks of acute and chronic kidney disease are increased both with HIV infection and with older age.
As in the general population, CKD is associated with increased cardiovascular risk in HIV-infected adults. This risk may be more pronounced than in the general population as HIV and CKD are independent risk factors for cardiovascular disease
In the USA, CKD affects nearly 12% of the adult population [17]. Diabetes and hypertension are the two leading causes, accounting for 64% of prevalent end-stage renal disease (ESRD) cases in the USA [18]. Black race is a strong risk factor for CKD and CKD progression
The increased prevalence of CKD in HIV-infected adults reflects a growing prevalence of the traditional CKD risk factors and the contribution of HIV-related factors. Unique risk factors for CKD in this population include low CD4 cell count and high HIV viral load, as well as other exposures that may be more common among HIV-infected adults, including hepatitis C virus infection, cigarette smoking, and injection drug use [24,25⋅,27,33⋅,34,35]. A growing body of literature, discussed in the next section, suggests that a high rate of AKI may also contribute to CKD risk among HIV-infected individuals.
older adults with HIV infection are at increased risk for polypharmacy and related medication nephrotoxicity
Diabetes and hypertension are the two leading causes, accounting for 64% of prevalent end-stage renal disease (ESRD) cases in the USA
Older adults are at increased risk for CKD as a result of increasing comorbidity and a physiologic decline in GFR with age
An analysis of data from 31 072 adults in the Veterans Aging Cohort Study (VACS) demonstrated that, compared with veterans without HIV or diabetes, the relative rate of progression to eGFR less than 45 ml/min/1.73 m2 was increased in those with HIV only (hazard ratio 2.8, 95% CI 2.5-3.15), diabetes only (hazard ratio 2.5, 95% CI 2.2-2.8), and concomitant HIV and diabetes (hazard ratio 4.5, 95% CI 3.9-5.2) [25⋅]. The conclusion that HIV and diabetes may have an additive effect on CKD risk is consistent with data from a mouse model of diabetic kidney disease, which demonstrates a more aggressive phenotype in mice expressing an HIV-1 transgene
The increased prevalence of CKD in HIV-infected adults reflects a growing prevalence of the traditional CKD risk factors and the contribution of HIV-related factors. Unique risk factors for CKD in this population include low CD4 cell count and high HIV viral load, as well as other exposures that may be more common among HIV-infected adults, including hepatitis C virus infection, cigarette smoking, and injection drug use
HIV-infected adults are at risk for nephrotoxicity from medications used to treat HIV, opportunistic infections, and associated comorbid conditions. Both HIV infection and older age have also been associated with polypharmacy [12,39], further increasing the risk of medication toxicity in older adults with HIV infection
The risk of acute kidney injury (AKI) also increases with age [3,4], and both CKD and AKI are strongly associated with adverse long-term outcomes in the general population [5,6].
The risks of CKD and AKI are higher in HIV-infected adults than in the general population
The diagnosis and management of kidney disease in HIV-infected adults are increasingly important with aging of the population.....With aging of the HIV-positive population, HIV providers will encounter a growing number of patients with comorbid CKD.....The burden of age-related CKD is greatest in minority populations at highest risk for HIV infection and for whom specialty care may be the least accessible
The prevalence of CKD also increases dramatically in older adults, affecting more than 60% of United States adults at least 80 years of age [2]. Older adults are at increased risk for CKD as a result of increasing comorbidity and a physiologic decline in GFR with age. On average, individuals over 60 years of age have 20-30% lower GFR than those younger than 50 years [20], consequent to structural and functional changes in the aging kidney that are accelerated in association with comorbidities including hypertension, diabetes, and cardiovascular disease [21].
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