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
Date Published2012 Oct
KeywordsAIDS-Associated Nephropathy, Disease Progression, Female, Glomerular Filtration Rate, Humans, Kidney, Male, Proportional Hazards Models, Renal Insufficiency, Chronic, Young Adult

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.

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