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Chronic renal failure among HIV-1-infected patients

Mocroft, Amandaa; Kirk, Oleb; Gatell, Josec; Reiss, Peterd; Gargalianos, Panagiotise; Zilmer, Kaif; Beniowski, Marekg; Viard, Jean-Paulh; Staszewski, Schlomoi; Lundgren, Jens Db; for the EuroSIDA Study Group

doi: 10.1097/QAD.0b013e3280f774ee
Clinical Science

Background: The role of exposure to antiretrovirals in chronic renal failure (CRF) is not well understood. Glomerular filtration rates (GFR) are estimated using the Cockcroft–Gault (CG) or Modification of Diet in Renal Disease (MDRD) equations.

Methods: Baseline was arbitrarily defined as the first recorded GFR; patients with two consecutive GFR ≤ 60 ml/min per 1.73 m2 were defined as having CRF. Logistic regression was used to determine odds ratio (OR) of CRF at baseline. ART exposure (yes/no or cumulative exposure) prior to baseline was included in multivariate models (adjusted for region of Europe, age, prior AIDS, CD4 cell count nadir, viral load, hypertension and use of nephrotoxic anti-infective therapy).

Results: Using CG, the median GFR at baseline (n = 4474) was 94.4 (interquartile range, 80.5–109.3); 158 patients (3.5%) had CRF. Patients with CRF were older (median, 61.9 versus 43.1 years), had lower CD4 cell count nadirs (median, 80 versus 137 cells/μl), and were more likely to be diagnosed with AIDS (44.3 versus 30.4%), diabetes (16.5 versus 4.3%) or hypertension (53.8 versus 26.4%), all P < 0.001. In a multivariate model any use of indinavir [odds ratio (OR) 2.49; 95% confidence interval (CI), 1.62–3.83] or tenofovir (OR, 2.18; 95% CI, 1.25–3.81) was associated with increased odds of CRF, as was cumulative exposure to indinavir (OR, 1.15 per year of exposure; 95% CI, 1.06–1.25) or tenofovir (OR, 1.60; 95% CI, 1.20–2.15). Highly consistent results were seen using the MDRD formula.

Conclusions: Among antiretrovirals, only exposure to indinavir or tenofovir was associated with increased odds of CRF. We used a confirmed low GFR to define CRF to increase the robustness of our analysis, although there are several potential biases associated with this cross-sectional analysis.

From the aRoyal Free and University College Medical School, London, UK

bCopenhagen HIV Program, Hvidovre, Denmark

cHospital Clinic i Provincial, Barcelona, Spain

dAcademisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands

eAthens General Hospital, Athens, Greece

fWest-Tallinn Central Hospital, Tallinn, Estonia

gMedical University of Silesia in Katowice, Chorzow, Poland

hHôpital Necker-Enfants Malades, Paris, France

iJW Goethe University Hospital, Frankfurt, Germany.

*See Acknowledgements.

Received 18 December, 2006

Revised 24 January, 2007

Accepted 8 February, 2007

Correspondence to Dr A Mocroft, Royal Free Centre for HIV Medicine and Dept Primary Care and Population Sciences, Royal Free and University College London Medical Schools, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK. E-mail: a.mocroft@pcps.ucl.ac.uk

© 2007 Lippincott Williams & Wilkins, Inc.