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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

doi: 10.1097/QAD.0000000000000134
Clinical Science

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.

aDepartment of Infection and Population Health, University College London, London, UK

bCopenhagen HIV Program

cDepartment of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark

dUniversity Hospital of Infectious Diseases, Zagreb, Croatia

eDepartment of Health Sciences, Institute of Infectious Diseases, Milan, Italy

fBelarus State Medical University, Minsk, Belarus

gHospital Clinic i Provincial, Barcelona, Spain

hInstitute of Tropical Medicine, Antwerp, Belgium

iUllevål University Hospital, Ullevål, Norway.

*Study group listed in appendix.

Correspondence to Amanda Mocroft, Department of Infection and Population Health, University College London, Rowland Hill St, London NW3 2PF, UK. Tel: +44 2077940500x33194; e-mail: a.mocroft@ucl.ac.uk

Received 6 August, 2013

Revised 30 October, 2013

Accepted 30 October, 2013

© 2014 Lippincott Williams & Wilkins, Inc.