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

Department of Clinical Medicine

18 Citations (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.

Original language	English
Journal	AIDS
Volume	28
Issue number	5
Pages (from-to)	727-37
Number of pages	11
ISSN	0269-9370
DOIs	https://doi.org/10.1097/qad.0000000000000134
Publication status	Published - 13 Mar 2014

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/qad.0000000000000134

Cite this

@article{cd861ebdd1bf40bebf52ffa1a25850f3,

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

Abstract

Keywords

UN SDGs

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