Renal function and incidence of chronic kidney disease in HIV patients: A Danish cohort study

Abstract Background: Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients. Methods: We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients a...

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Published in:Scandinavian journal of infectious diseases Vol. 44; no. 9; pp. 689 - 696
Main Authors: Rasch, Magnus G., Engsig, Frederik N., Feldt-Rasmussen, Bo, Kirk, Ole, Kronborg, Gitte, Pedersen, Court, Gerstoft, Jan, Obel, Niels
Format: Journal Article
Language:English
Published: England Informa Healthcare 01.09.2012
Taylor & Francis
Subjects:
Adenine - adverse effects
Adenine - analogs & derivatives
Adenine - therapeutic use
Adult
Anti-HIV Agents - adverse effects
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active
atazanavir
Atazanavir Sulfate
Chronic kidney disease
Cohort Studies
Denmark - epidemiology
Female
Glomerular Filtration Rate - drug effects
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - physiopathology
Humans
Incidence
Kidney - drug effects
Kidney - physiopathology
Linear Models
Male
Middle Aged
Oligopeptides - adverse effects
Oligopeptides - therapeutic use
Organophosphonates - adverse effects
Organophosphonates - therapeutic use
Pyridines - adverse effects
Pyridines - therapeutic use
renal function
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - virology
Tenofovir
Denmark
ISSN:0036-5548, 1651-1980, 1651-1980
Online Access:Get full text
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Summary:Abstract Background: Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients. Methods: We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients and stratified on baseline eGFR (eGFRB) < 90 and ≥ 90 ml/min per 1.73 m2. Incidence rate ratios (IRRs) for chronic kidney disease (CKD) - 2 consecutive eGFR values < 60 ml/min per 1.73 m2 measured > 3 months apart - were estimated (time-updated Cox-regression model). Results: The effect of time with HIV on eGFR was small in both strata (− 0.09 (95% confidence interval (CI) − 0.27, 0.09) and − 0.46 (95% CI − 0.64, − 0.27) ml/min per 1.73 m2 per y). Treatment with tenofovir and indinavir was associated with lower eGFR in both strata: tenofovir − 2.00 (95% CI − 3.45, − 0.56) and − 1.94 (95% CI − 3.43, − 0.44) ml/min per 1.73 m2 and indinavir − 2.14 (95% CI − 3.63, − 0.64) and − 3.29 (95% CI − 5.25, − 1.32) ml/min per 1.73 m2. Nevirapine, atazanavir, and the combination of tenofovir and atazanavir were associated with lower eGFR in patients with eGFRB < 90 ml/min per 1.73 m2. Highly active antiretroviral therapy (HAART) and exposure to tenofovir and atazanavir in combination were associated with CKD in patients with eGFRB < 90 ml/min per 1.73 m2 (adjusted IRRs 6.08 (95% CI 2.76-13.41) and 26.75 (95% CI 9.54-75.05)). Conclusion: Tenofovir and indinavir reduce eGFR, while time with HIV only has a modest effect on this parameter. Low eGFRB is associated with an increased risk of CKD, especially when receiving HAART regimens containing the combination tenofovir/atazanavir.
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ISSN:0036-5548
1651-1980
1651-1980
DOI:10.3109/00365548.2012.673730