Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals

TY - JOUR

T1 - Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals

AU - Ryom, Lene

AU - Mocroft, Amanda

AU - Kirk, Ole

AU - Reiss, Peter

AU - Ross, Michael

AU - Smith, Colette

AU - Moranne, Olivier

AU - Morlat, Philippe

AU - Fux, Christoph A

AU - Sabin, Caroline

AU - Phillips, Andrew

AU - Law, Matthew

AU - Lundgren, Jens D

AU - D:A:D Study Group

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objectives: The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. Design: Prospective observational study. Methods: The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m2 or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m2), stabilization (-10 to +10 ml/min per 1.73 m2) and progression (<-10 ml/min per 1.73 m2). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression. Results: Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes. Conclusion: Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.

AB - Objectives: The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. Design: Prospective observational study. Methods: The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m2 or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m2), stabilization (-10 to +10 ml/min per 1.73 m2) and progression (<-10 ml/min per 1.73 m2). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression. Results: Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes. Conclusion: Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.

KW - Adult

KW - Aged

KW - Anti-HIV Agents/adverse effects

KW - Antiretroviral Therapy, Highly Active/adverse effects

KW - Female

KW - Glomerular Filtration Rate

KW - HIV Infections/complications

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Prospective Studies

KW - Renal Insufficiency, Chronic/pathology

U2 - 10.1097/QAD.0000000000001464

DO - 10.1097/QAD.0000000000001464

M3 - Journal article

C2 - 28492392

SN - 0269-9370

VL - 31

SP - 1261

EP - 1270

JO - AIDS

JF - AIDS

IS - 9

ER -