The incidence of and risk factors for hospitalized acute kidney injury among people living with HIV on antiretroviral treatment

被引:3
作者
Muiru, Anthony N. [1 ,2 ]
Madden, Erin [1 ,3 ]
Chilingirian, Ani [1 ]
Rubinsky, Anna D. [4 ]
Scherzer, Rebecca [1 ,3 ]
Moore, Richard [5 ]
Villalobos, Celia P. Corona [5 ]
Trujillo, Jose Manuel Monroy [5 ]
Parikh, Chirag R. [5 ]
Hsu, Chi-Yuan [2 ]
Shlipak, Michael G. [1 ,3 ]
Estrella, Michelle M. [1 ,2 ,3 ]
机构
[1] Univ Calif San Francisco, Dept Med, Kidney Hlth Res Collaborat, 533 Parnassus Ave,U404,Box 0532, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Med, Div Nephrol, San Francisco, CA 94143 USA
[3] San Francisco VA Hlth Care Syst, San Francisco, CA USA
[4] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[5] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
关键词
acute kidney injury; antiretroviral therapy; chronic kidney disease; HIV; proteinuria; HUMAN-IMMUNODEFICIENCY-VIRUS; ACUTE-RENAL-FAILURE; POSITIVE PATIENTS; INFECTED ADULTS; DISEASE; NEPHROPATHY; PREVENTION; OUTCOMES; THERAPY; HEALTH;
D O I
10.1111/hiv.13216
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives The epidemiology of hospitalized acute kidney injury (AKI) among people living with HIV (PLWH) in the era of modern antiretroviral therapy (ART) for all PLWH is not well characterized. We evaluated the incidence of and risk factors for hospitalized AKI from 2005 to 2015 among PLWH on ART. Methods We conducted a retrospective analysis of PLWH from the Johns Hopkins HIV Clinical Cohort. We defined hospitalized AKI as a rise of >= 0.3 mg/dL in serum creatinine (SCr) within any 48-h period or a 50% increase in SCr from baseline and assessed associations of risk factors with incident AKI using multivariate Cox regression models. Results Most participants (75%) were black, 34% were female, and the mean age was 43 years. The incidence of AKI fluctuated annually, peaking at 40 per 1000 person-years (PY) [95% confidence interval (CI) 22-69 per 1000 PY] in 2007, and reached a nadir of 20 per 1000 PY (95% CI 11-34 per 1000 PY) in 2010. There was no significant temporal trend (-3.3% change per year; 95% CI -8.6 to 2.3%; P = 0.24). After multivariable adjustment, characteristics independently associated with AKI included black race [hazard ratio (HR) 2.44; 95% CI 1.42-4.20], hypertension (HR 1.62; 95% CI 1.09-2.38), dipstick proteinuria > 1 (HR 1.86; 95% CI 1.07-3.23), a history of AIDS (HR 1.82; 95% CI 1.29-2.56), CD4 count < 200 cells/mu L (HR 1.46; 95% CI 1.02-2.07), and lower serum albumin (HR 1.73 per 1 g/dL decrease; 95% CI 1.02-2.07). Conclusions In this contemporary cohort of PLWH, the annual incidence of first AKI fluctuated during the study period. Attention to modifiable AKI risk factors and social determinants of health may further reduce AKI incidence among PLWH.
引用
收藏
页码:611 / 619
页数:9
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