Abstract
This single-center cross-sectional study determined the prevalence and factors associated with chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-1-infected Asian patients at the largest HIV clinic in Japan. HIV-1-infected patients who visited the clinic between September and December 2016 were analyzed. CKD was defined as estimated glomerular filtration rate of <60 ml/min/1.73 m2 or proteinuria ≥1+, observed at least over three months. A logistic regression model was used to estimate the effects of various variables on CKD. The study included 1,990 patients; with 97% Asians, 34% aged of ≥50 years, and 94% had HIV-1 load <50 copies/ml. The median time from HIV-1 diagnosis to study enrollment and duration of ART were 9.1 years (IQR4.8–14.2) and 7.35 years (IQR3.28–12), respectively. CKD and ESRD were diagnosed in 256 (13%) and 9 (0.5%) patients, respectively. The prevalence of CKD was 18.6% for age 50–59, 28.5% for 60–69, and 47% for over 70. Older age, heavier body weight, diabetes mellitus, hypertension, and longer duration of ART, but not duration of TDF exposure, were associated with CKD. The traditional risk factors, rather than HIV-1-related variables, were associated with CKD, suggesting the importance of management of such comorbidities in maintenance of renal function.
Highlights
The advent of antiretroviral therapy (ART) substantially improved the prognosis of patients with HIV-1 infection[1]
The aim of the present study was to determine the prevalence and factors associated with chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-1-infected patients in Asia, with a particular focus on tenofovir disoproxil fumarate (TDF) nephrotoxicity, and to define the clinical characteristics of HIV-1-infected patients with ESRD
Older age, heavier body weight, diabetes mellitus, hypertension, dyslipidemia, history of AIDS, longer duration of ART, and longer time from diagnosis of HIV-1 infection were significantly associated with CKD
Summary
The advent of antiretroviral therapy (ART) substantially improved the prognosis of patients with HIV-1 infection[1]. With increased age of HIV-1-infected patients, the importance of management of non-communicable diseases (NCDs) cannot be overemphasized[2]. The rate of deterioration of renal function is reported to be faster in HIV1-infected patients than the general population[5,6]. Few studies in Asia have assessed the prevalence and factors associated with CKD and ESRD in patients with HIV-1 infection[7,8,9]. HIV1-infected Asians are living longer, especially in resource-rich setting, and this further highlights the importance of maintenance of renal function in such patients. The aim of the present study was to determine the prevalence and factors associated with CKD and ESRD in HIV-1-infected patients in Asia, with a particular focus on TDF nephrotoxicity, and to define the clinical characteristics of HIV-1-infected patients with ESRD
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