Renal function and incidence of chronic kidney disease in HIV patients: a Danish cohort study

TY - JOUR

T1 - Renal function and incidence of chronic kidney disease in HIV patients

T2 - a Danish cohort study

AU - Rasch, Magnus G.

AU - Engsig, Frederik N

AU - Feldt-Rasmussen, Bo

AU - Kirk, Ole

AU - Kronborg, Gitte

AU - Pedersen, Court

AU - Gerstoft, Jan

AU - Obel, Niels

PY - 2012/9

Y1 - 2012/9

N2 - Background: Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients. Methods: We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients and stratified on baseline eGFR (eGFRB) <90 and ≥90 ml/min per 1.73 m 2. Incidence rate ratios (IRRs) for chronic kidney disease (CKD) 2 consecutive eGFR values <60 ml/min per 1.73 m2 measured >3 months apart were estimated (time-updated Cox-regression model). Results: The effect of time with HIV on eGFR was small in both strata (- 0.09 (95% confidence interval (CI) - 0.27, 0.09) and - 0.46 (95% CI - 0.64, - 0.27) ml/min per 1.73 m2 per y). Treatment with tenofovir and indinavir was associated with lower eGFR in both strata: tenofovir - 2.00 (95% CI - 3.45, - 0.56) and - 1.94 (95% CI - 3.43, - 0.44) ml/min per 1.73 m2 and indinavir - 2.14 (95% CI - 3.63, - 0.64) and - 3.29 (95% CI - 5.25, - 1.32) ml/min per 1.73 m 2. Nevirapine, atazanavir, and the combination of tenofovir and atazanavir were associated with lower eGFR in patients with eGFRB <90 ml/min per 1.73 m2. Highly active antiretroviral therapy (HAART) and exposure to tenofovir and atazanavir in combination were associated with CKD in patients with eGFRB <90 ml/min per 1.73 m2 (adjusted IRRs 6.08 (95% CI 2.7613.41) and 26.75 (95% CI 9.5475.05)). Conclusion: Tenofovir and indinavir reduce eGFR, while time with HIV only has a modest effect on this parameter. Low eGFRB is associated with an increased risk of CKD, especially when receiving HAART regimens containing the combination tenofovir/atazanavir.

AB - Background: Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients. Methods: We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients and stratified on baseline eGFR (eGFRB) <90 and ≥90 ml/min per 1.73 m 2. Incidence rate ratios (IRRs) for chronic kidney disease (CKD) 2 consecutive eGFR values <60 ml/min per 1.73 m2 measured >3 months apart were estimated (time-updated Cox-regression model). Results: The effect of time with HIV on eGFR was small in both strata (- 0.09 (95% confidence interval (CI) - 0.27, 0.09) and - 0.46 (95% CI - 0.64, - 0.27) ml/min per 1.73 m2 per y). Treatment with tenofovir and indinavir was associated with lower eGFR in both strata: tenofovir - 2.00 (95% CI - 3.45, - 0.56) and - 1.94 (95% CI - 3.43, - 0.44) ml/min per 1.73 m2 and indinavir - 2.14 (95% CI - 3.63, - 0.64) and - 3.29 (95% CI - 5.25, - 1.32) ml/min per 1.73 m 2. Nevirapine, atazanavir, and the combination of tenofovir and atazanavir were associated with lower eGFR in patients with eGFRB <90 ml/min per 1.73 m2. Highly active antiretroviral therapy (HAART) and exposure to tenofovir and atazanavir in combination were associated with CKD in patients with eGFRB <90 ml/min per 1.73 m2 (adjusted IRRs 6.08 (95% CI 2.7613.41) and 26.75 (95% CI 9.5475.05)). Conclusion: Tenofovir and indinavir reduce eGFR, while time with HIV only has a modest effect on this parameter. Low eGFRB is associated with an increased risk of CKD, especially when receiving HAART regimens containing the combination tenofovir/atazanavir.

U2 - 10.3109/00365548.2012.673730

DO - 10.3109/00365548.2012.673730

M3 - Journal article

C2 - 22680981

SN - 0036-5548

VL - 44

SP - 689

EP - 696

JO - Scandinavian Journal of Infectious Diseases

JF - Scandinavian Journal of Infectious Diseases

IS - 9

ER -