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Advanced renal disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

DOI: 10.7448/ias.15.6.18136

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Abstract:

Many studies have focused on chronic kidney disease in HIV-positive individuals, but few have studied the less frequent events, advanced renal disease (ARD) and end-stage renal disease (ESRD). The aim of this study was to investigate incidence, predictors and outcomes for ARD/ESRD and renal death in EuroSIDA. ARD was defined as confirmed eGFR < 30 ml/min per 1.73 m2 (>3 months apart) using Cockcroft-Gault. ESRD was defined as hemo- or peritoneal dialysis>1 month/renal transplant. Renal deaths were defined as renal failure as the underlying cause of death, using CoDe methodology. Patients were followed from baseline (first eGFR after 1/1/2004) until last eGFR, ARD/ESRD/renal death; whichever occurred first. Poisson regression was used to identify predictors. 8817 persons were included, the majority were white (87.3%), males (73.9%) infected though homosexual contact (41.5%) and with a median age of 42 years (IQR 36–49). 45 persons (0.5%) developed the composite endpoint; ARD (24), ESRD (19) and renal death (2) during a median follow up (FU) of 4.5 years (IQR 2.7–5.8), incidence rate (IR) 1.21/1000 PYFU (95% CI 0.86–1.57). Of 312 persons (3.5%) with baseline eGFR<60 ml/min/1.73 m2, 13.3% (7.5–18.9) are estimated to develop ARD/ESRD/renal death within 6 years after baseline compared to 0.86% (0.58–1.1) of all patients, using Kaplan-Meier methods. Predictors in multivariate analysis were older age (IRR 1.29 per 10 years [0.95–1.75]) any cardiovascular risk (IRR 2.34 [1.23–4.45]), CD4 count (IRR 0.76 per 2-fold higher [0.60–0.97]) and eGFR (IRR 0.63 per 5 ml/min/1.73 m2 higher [0.58–0.69]). Ethnicity, gender, nadir CD4, VL, HBV and using potential nephrotoxic antiretrovirals were insignificant in uni- and multivariate analysis. At 1 year after ARD/ESRD, 23.3% (CI 9.8–36.8) were estimated to have died using Kaplan-Meier methods. The 11 deaths were from renal causes (2), non-AIDS-defining malignancies (2), hepatitis-associated liver failure (1), respiratory failure (1), cardiovascular disease (1), pancreatitis (1) and unknown causes (3). The ARD/ESRD/renal death incidence was low in this population with the available FU, and was associated with traditional and HIV-related risk factors. Most persons with ARD/ESRD/renal death had pre-existing renal impairment, but some experienced a rapid progression from initial normal levels. Prognosis after ARD/ESRD was poor. Larger studies are required to address the possible contribution of specific antiretrovirals.

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