HIVAN and medication use in chronic dialysis patients in the United States: Analysis of the USRDS DMMS Wave 2 study

被引：37
作者：
Kevin C Abbott
Fernando C Trespalacios
Lawrence Y Agodoa
Tejinder S Ahuja
机构：
[1] Nephrology Service, Walter Reed Army Medical Center, Washington, DC
[2] Uniformed Serv. Univ. Hlth. Sci., Bethesda, MD
[3] Nephrology Service, Madigan Army Medical Center, Washington, DC
[4] NIDDK, NIH, Bethesda, MD
[5] Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, TX
来源：
BMC Nephrology | / 4卷 / 1期
关键词：
HIV; antiretroviral; angiotensin converting enzyme inhibitors; dialysis; end-stage renal disease; calcium channel blockers; dihydropyridine; USRDS; heart failure; hyperparathyroidism;
D O I：
10.1186/1471-2369-4-5
中图分类号：
学科分类号：
摘要：
Background: The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN), namely of angiotensin converting enzyme inhibitors (ACE) and antiretroviral therapy, has not been reported for a national sample of dialysis patients. Methods: We conducted a historical cohort study of the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR) with HIVAN as a cause of end stage renal disease (ESRD) and its impact on mortality during the study period, adjusted for potential confounders. Results: Of the 3374 patients who started dialysis, 36 (1.1%) had ESRD as a result of HIVAN. Only 22 (61%) of patients with HIVAN received antiretroviral agents, and only nine patients (25%) received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60), or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p < 0.01) compared to patients with other causes of ESRD. Conclusions: Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.
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页码：1 / 7
页数：6
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