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

Ibrahim, Fowzia, Hamzah, Lisa, Jones, Rachael, Nitsch, Dorothea, Sabin, Caroline, Post, Frank A, Fisher, Martin and The UK Collaborative HIV Cohort (CHIC)/ CKD Study Group, (2012) Baseline kidney function as predictor of mortality and kidney disease progression in HIV-positive patients. American Journal of Kidney Diseases, 60 (4). pp. 539-547. ISSN 0272-6386

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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.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
Related URLs:
Depositing User: Ellen Thomas
Date Deposited: 02 Dec 2013 09:08
Last Modified: 02 Dec 2013 09:08
URI: http://sro.sussex.ac.uk/id/eprint/47077
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