Baseline kidney function as predictor of mortality and kidney disease progression in HIV-positive patients.

TitleBaseline kidney function as predictor of mortality and kidney disease progression in HIV-positive patients.
Publication TypeJournal Article
Year of Publication2012
AuthorsIbrahim F, Hamzah L, Jones R, Nitsch D, Sabin C and Post F
Corporate AuthorsUK Collaborative HIV Cohort(CHIC)/CKD Study Group
JournalAm J Kidney Dis
Volume60
Issue4
Pagination539-47
Date Published2012 Oct
ISSN1523-6838
KeywordsAIDS-Associated Nephropathy, Disease Progression, Female, Glomerular Filtration Rate, Humans, Kidney, Male, Proportional Hazards Models, Renal Insufficiency, Chronic, Young Adult
Abstract

BACKGROUND: Chronic kidney disease (CKD) is associated with increased all-cause mortality and kidney disease progression. Decreased kidney function at baseline may identify human immunodeficiency virus (HIV)-positive patients at increased risk of death and kidney disease progression.STUDY DESIGN: Observational cohort study.SETTING & PARTICIPANTS: 7 large HIV cohorts in the United Kingdom with kidney function data available for 20,132 patients.PREDICTOR: Baseline estimated glomerular filtration rate (eGFR).OUTCOMES: Death and progression to stages 4-5 CKD (eGFR <30 mL/min/1.73 m(2) for >3 months) in Cox proportional hazards and competing-risk regression models.RESULTS: Median age at baseline was 34 (25th-75th percentile, 30-40) years, median CD4 cell count was 350 (25th-75th percentile, 208-520) cells/μL, and median eGFR was 100 (25th-75th percentile, 87-112) mL/min/1.73 m(2). Patients were followed up for a median of 5.3 (25th-75th percentile, 2.0-8.9) years, during which 1,820 died and 56 progressed to stages 4-5 CKD. A U-shaped relationship between baseline eGFR and mortality was observed. After adjustment for potential confounders, eGFRs <45 and >105 mL/min/1.73 m(2) remained associated significantly with increased risk of death. Baseline eGFR <90 mL/min/1.73 m(2) was associated with increased risk of kidney disease progression, with the highest incidence rates of stages 4-5 CKD (>3 events/100 person-years) observed in black patients with eGFR of 30-59 mL/min/1.73 m(2) and those of white/other ethnicity with eGFR of 30-44 mL/min/1.73 m(2).LIMITATIONS: The relatively small numbers of patients with decreased eGFR at baseline and low rates of progression to stages 4-5 CKD and lack of data for diabetes, hypertension, and proteinuria.CONCLUSIONS: Although stages 4-5 CKD were uncommon in this cohort, baseline eGFR allowed the identification of patients at increased risk of death and at greatest risk of kidney disease progression.

DOI10.1053/j.ajkd.2012.03.006
Alternate JournalAm. J. Kidney Dis.
PubMed ID22521282
PubMed Central IDPMC3657190
Grant ListDRF-2009-02-54 / / Department of Health / United Kingdom
G00001999 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom