Ryom L, Lundgren JD, Law M, Kirk O, El-Sadr W, Bonnet F, Weber R, Fontas E, Monforte AD, Phillips A, Reiss P, de Wit S, Hatleberg CI, Sabin C, Mocroft A; D:A:D study group.
AIDS. 2019 Aug 2. doi: 10.1097/QAD.0000000000002331. [Epub ahead of print]
Predictors of chronic kidney disease (CKD) amongst HIV-positive persons are well established, but insights into the prognosis after CKD including the role of modifiable risk factors are limited.
Prospective cohort study METHODS:: D:A:D participants developing CKD (confirmed, >3 months apart, eGFR ≤ 60 mL/min/1.73 m or 25% eGFR decrease when eGFR ≤ 60) were followed to incident serious clinical events (SCE); end stage renal (ESRD) and liver disease, cardiovascular disease (CVD), AIDS- and non-AIDS defining malignancies (NADM), other AIDS or death, 6 months after last visit or 02.01.2016. Poisson regression models considered associations between SCE and modifiable risk factors.
During 2.7 (IQR 1.1-5.1) years median follow-up 595 persons with CKD (24.1%) developed a SCE (incidence rate 68.9/1000 PYFU [95%CI 63.4-74.4]) with 8.3% [6.9-9.0] estimated to experience any SCE at one year. The most common SCE was death (12.7%), followed by NADM (5.8%), CVD (5.6%), other AIDS (5.0%) and ESRD (2.9%). Crude SCE ratios were significantly higher in those with vs. without CKD, strongest for ESRD (65.9 [43.8-100.9]) and death (4.8 [4.3-5.3]). Smoking was consistently associated with all CKD-related SCE. Diabetes predicted CVD, NADM and death, while dyslipidaemia was only significantly associated with CVD. Poor HIV-status predicted other AIDS and death, eGFR < 30 mL/min/1.73m predicted CVD and death and low BMI predicted other AIDS and death.
In an era where many HIV-positive persons require less monitoring due to efficient antiretroviral treatment, persons with CKD carry a high burden of SCE. Several potentially modifiable risk factors play a central role for CKD-related morbidity and mortality.