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doi: 10.1097/QAD.0000000000000134
Clinical Science

Deteriorating renal function and clinical outcomes in HIV-positive persons

Mocroft, Amandaa; Ryom, Leneb,c; Begovac, Josipd; Monforte, Antonella D’Arminioe; Vassilenko, Annef; Gatell, Joseg; Florence, Erich; Ormaasen, Vidari; Kirk, Oleb,c; Lundgren, Jens D.b,c; for EuroSIDA in EuroCOORD

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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.

© 2014 Lippincott Williams & Wilkins, Inc.


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