Abstract
We aimed to explore acute kidney injury (AKI) Kidney Disease Improving Global Guidelines (KDIGO) stage 2 to 3 in a cohort of antiretroviral treated HIV-infected individuals. HIV-infected individuals of the Swiss HIV Cohort Study (Basel site), treated with combination antiretroviral therapy (cART) 2002-2013, were included. AKI was defined and classified according to the KDIGO Clinical Practice Guidelines for AKI. Data were prospectively collected and reports of kidney biopsies obtained from records. Among 1,153 cART-treated patients, 13 experienced AKI KDIGO stage 2 to 3 (1 patient stage 2, 12 patients stage 3; median age 46 years; 9 male; median CD4 count 366 cells/μl), corresponding to an incidence rate of AKI of 0.77 (95% confidence interval 0.45-1.33) per 1000 patient-years. Baseline estimated glomerular filtration rate (eGFR) was 87 ml/min (interquartile range 66-100). Ten patients were treated with tenofovir (TDF). Nine patients (69%) had ≥1 cardiovascular risk factor, only two patients had known pre-existing kidney disease. Three patients needed chronic and two temporary dialysis. AKI was associated with TDF therapy in 6 of 13 (46%) patients (mean TDF exposure time before AKI 41 months). Impaired renal function was partially reversible in all patients. In three patients with biopsy-proven pre-existing kidney disease (AA amyloidosis, calcineurin inhibitor-induced nephropathy and minimal change glomerulopathy), TDF potentially added to AKI. AKI KDIGO stage 2 to 3 demonstrates complex associations at the individual level and can occur without early signs. Although treatment with TDF and presence of cardiovascular risk factors were found frequently, predicting AKI seems very difficult.
Highlights
Acute kidney injury (AKI) has been associated with increased morbidity and mortality in HIV-infected patients [1, 2]
acute kidney injury (AKI) was associated with TDF therapy in 6 of 13 (46%) patients
In three patients with biopsy-proven pre-existing kidney disease (AA amyloidosis, calcineurin inhibitor-induced nephropathy and minimal change glomerulopathy), TDF potentially added to AKI
Summary
Acute kidney injury (AKI) has been associated with increased morbidity and mortality in HIV-infected patients [1, 2]. The leading causes of AKI in the era before combination antiretroviral therapy (cART) were mainly volume depletion, sepsis and drug-related toxicity due to treatment of opportunistic infections [3, 4]. Lower CD4 cell counts, an AIDS-defining disease, co-infection with hepatitis C virus and liver disease have been reported as risk factors for AKI in HIV-infected individuals [5]. Since cART has dramatically increased life expectancy, aging has become an additional risk factor for AKI as a result of atherosclerosis, metabolic disease, and long-term use of nephrotoxic drugs, in particular tenofovir (TDF) and protease inhibitors [7]. The aim of this study was to explore AKI Kidney Disease Improving Global Guidelines (KDIGO) stage 2 to 3 in a cohort of treated HIV-infected individuals at a tertiary-care hospital
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