Incidence and risk factors of chronic renal disease in a cohort of Greek HIV‐1‐infected adults

Abstract

Chronic kidney disease (CKD) in HIV‐infected patients is associated with both HIV and non‐HIV‐related factors. Initial renal dysfunction is silent and detectable only by laboratory tests such as the glomerular filtration rate (GFR) estimated by the Cockcroft‐Gault equation. Our objective was to assess possible risk factors for CKD in a cohort of Greek HIV‐1‐infected adults.MethodsPatients in the AMACS (Athens Multicenter AIDS Cohort Study) cohort with at least two available creatinine values were enrolled in the study. Renal dysfunction was defined as eGFR below 90 mL/min/1.73 m2. The Kaplan‐Meier estimator and the Cox proportional hazards model were used to analyze the occurrence and predictors of renal dysfunction.ResultsA total of 1073 patients were enrolled in the study; 255 (23.76%) had baseline eGFR below 90 mL/min/1.73 m2 and were excluded. Characteristics of the study population: men 88.4%, MSM 62.6%, median baseline age, CD4+count and viral load were 32.6 years, 413 cells/µL and 3.77 log10 copies/mL, respectively. 240 (29.3%) patients experienced an eGFR decrease below 90 mL/min/1.73 m2 during follow‐up period. Older age, female gender, heterosexual mode of transmission, lower baseline eGFR (all p<0.001), lower baseline CD4+(p=0.001), stage C (p=0.023), administration of cART (p<0.001) or other nephrotoxic agent (p=0.035) were the major risk factors in univariable analysis. Multivariable analysis identified older age [hazard ratio (HR) 1.289 per 10 years, p<0.001] and female gender (HR vs male: 1.899, p<0.001), as the major factors associated with increased hazard of developing CRD, whereas baseline eGFR <110 (HR vs eGFR <110: 0.245, p<0.001) and current CD4+count ≥350 cells/µL (HR 0.564, p=0.003) were significant protective factors.ConclusionIn this large cohort of HIV‐infected Greek patients, almost one‐third (29.3%) experienced some degree of renal dysfunction during HIV infection. Older age and female gender were major predictors of CKD, whereas high current CD4+count and baseline eGFR were protective.