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Immunodeficiency and renal impairment are risk factors for HIV-associated acute renal failure

Ibrahim, Fowziaa; Naftalin, Claireb; Cheserem, Emilyb; Roe, Jenniferb; Campbell, Lucy Ja; Bansi, Loveleenc; Hendry, Bruce Ma; Sabin, Carolinec; Post, Frank Aa,b

doi: 10.1097/QAD.0b013e32833c85d6
Clinical Science

Objective: To identify risk factors for acute renal failure (ARF) in HIV-infected patients.

Design: Observational cohort study of HIV-infected patients attending a South London HIV centre between January 1999 and December 2008.

Methods: ARF was defined as a transient, more than 40% reduction in renal function as assessed by estimated glomerular filtration rate. Multivariate Poisson regression analysis was used to identify baseline and time-updated factors associated with ARF.

Results: The incidence of ARF was 2.8 (95% confidence interval 2.41–3.24) episodes per 100 person-years. We observed a stepwise increase in ARF incidence with time accrued at lower CD4 cell count and at lower estimated glomerular filtration rate, with adjusted incidence rate ratios of 1 (reference), 1.56 (0.97–2.48), 2.08 (1.11–3.91), 6.38 (3.18–12.78) and 10.29 (5.11–20.98) for CD4 cell counts of more than 350, 201–350, 101–200, 51–100 and of 50/μl or less, and 1 (reference), 1.46 (0.86–2.51), 4.19 (2.37–7.42) and 27.00 (16.13–44.95) for estimated glomerular filtration rate more than 90, 75–89, 60–74 and less than 60 ml/min, respectively. Ethnicity, hepatitis B or C coinfection, exposure to combination antiretroviral therapy with or without indinavir, tenofovir or atazanavir and HIV viraemia were not associated with ARF.

Conclusion: Current levels of immunodeficiency and renal function were independent predictors of HIV-associated ARF.

aKing's College London (KCL) School of Medicine, UK

bKing's College Hospital, UK

cUniversity College London (UCL) Medical School, London, UK.

Received 19 April, 2010

Revised 10 May, 2010

Accepted 27 May, 2010

Correspondence to Dr Frank A. Post, Clinical Senior Lecturer, King's College London School of Medicine, Weston Education Centre (Rm 2.53), Cutcombe Road, London SE5 9RJ, UK. E-mail: frank.post@kcl.ac.uk

© 2010 Lippincott Williams & Wilkins, Inc.