Deteriorating renal function and clinical outcomes in HIV-positive persons

Amanda Mocroft; Lene Ryom; Josip Begovac; Antonella D'Arminio Monforte; Anne Vassilenko; Jose Gatell; Eric Florence; Vidar Ormaasen; Ole Kirk; Jens D Lundgren; EuroSIDA in EuroCoord

doi:10.1097/qad.0000000000000134

Deteriorating renal function and clinical outcomes in HIV-positive persons

Amanda Mocroft, Lene Ryom, Josip Begovac, Antonella D'Arminio Monforte, Anne Vassilenko, Jose Gatell, Eric Florence, Vidar Ormaasen, Ole Kirk, Jens D Lundgren, EuroSIDA in EuroCoord

Institut for Klinisk Medicin

18 Citationer (Scopus)

Abstract

OBJECTIVES: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality.

DESIGN: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA.

METHODS: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events.

RESULTS: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24).

CONCLUSION: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.

Originalsprog	Engelsk
Tidsskrift	AIDS
Vol/bind	28
Udgave nummer	5
Sider (fra-til)	727-37
Antal sider	11
ISSN	0269-9370
DOI	https://doi.org/10.1097/qad.0000000000000134
Status	Udgivet - 13 mar. 2014

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title = "Deteriorating renal function and clinical outcomes in HIV-positive persons",

abstract = "OBJECTIVES: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality.DESIGN: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA.METHODS: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events.RESULTS: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24).CONCLUSION: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.",

keywords = "AIDS-Associated Nephropathy, Adult, Cohort Studies, Female, Glomerular Filtration Rate, HIV Infections, Humans, Longitudinal Studies, Male, Middle Aged, Prognosis, Renal Insufficiency, Survival Analysis",

author = "Amanda Mocroft and Lene Ryom and Josip Begovac and Monforte, {Antonella D'Arminio} and Anne Vassilenko and Jose Gatell and Eric Florence and Vidar Ormaasen and Ole Kirk and Lundgren, {Jens D} and {EuroSIDA in EuroCoord}",

year = "2014",

month = mar,

day = "13",

doi = "10.1097/qad.0000000000000134",

language = "English",

volume = "28",

pages = "727--37",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams & Wilkins",

number = "5",

}

TY - JOUR

T1 - Deteriorating renal function and clinical outcomes in HIV-positive persons

AU - Mocroft, Amanda

AU - Ryom, Lene

AU - Begovac, Josip

AU - Monforte, Antonella D'Arminio

AU - Vassilenko, Anne

AU - Gatell, Jose

AU - Florence, Eric

AU - Ormaasen, Vidar

AU - Kirk, Ole

AU - Lundgren, Jens D

AU - EuroSIDA in EuroCoord

PY - 2014/3/13

Y1 - 2014/3/13

N2 - OBJECTIVES: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality.DESIGN: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA.METHODS: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events.RESULTS: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24).CONCLUSION: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.

AB - OBJECTIVES: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality.DESIGN: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA.METHODS: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events.RESULTS: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24).CONCLUSION: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.

KW - AIDS-Associated Nephropathy

KW - Adult

KW - Cohort Studies

KW - Female

KW - Glomerular Filtration Rate

KW - HIV Infections

KW - Humans

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Renal Insufficiency

KW - Survival Analysis

U2 - 10.1097/qad.0000000000000134

DO - 10.1097/qad.0000000000000134

M3 - Journal article

C2 - 24983543

SN - 0269-9370

VL - 28

SP - 727

EP - 737

JO - AIDS

JF - AIDS

IS - 5

ER -

Deteriorating renal function and clinical outcomes in HIV-positive persons

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