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Comorbid Diabetes and the Risk of Progressive Chronic Kidney Disease in HIV-Infected Adults: Data From the Veterans Aging Cohort Study

Medapalli, Raj K. MD, MPH; Parikh, Chirag R. MD, PhD; Gordon, Kirsha MPhil; Brown, Sheldon T. MD; Butt, Adeel A. MD, MS; Gibert, Cynthia L. MD; Rimland, David MD; Rodriguez-Barradas, Maria C. MD; Chang, Chung-Chou H. PhD; Justice, Amy C. MD, PhD; He, John Cijiang MD; Wyatt, Christina M. MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2012 - Volume 60 - Issue 4 - p 393–399
doi: 10.1097/QAI.0b013e31825b70d9
Clinical Science

Introduction: Approximately, 15% of HIV-infected individuals have comorbid diabetes. Studies suggest that HIV and diabetes have an additive effect on chronic kidney disease (CKD) progression; however, this observation may be confounded by differences in traditional CKD risk factors.

Methods: We studied a national cohort of HIV-infected and matched HIV-uninfected individuals who received care through the Veterans Healthcare Administration. Subjects were divided into 4 groups based on baseline HIV and diabetes status, and the rate of progression to an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73m2 was compared using Cox-proportional hazards modeling to adjust for CKD risk factors.

Results: About 31,072 veterans with baseline eGFR ≥45 mL/min/1.73m2 (10,626 with HIV only, 5088 with diabetes only, and 1796 with both) were followed for a median of 5 years. Mean baseline eGFR was 94 mL/min/1.73m2, and 7% progressed to an eGFR < 45 mL/min/1.73m2. Compared with those without HIV or diabetes, the relative rate of progression was increased in individuals with diabetes only [adjusted hazard ratio (HR) 2.48; 95% confidence interval (CI): 2.19 to 2.80], HIV only [HR: 2.80, 95% CI: 2.50 to 3.15], and both HIV and diabetes [HR: 4.47, 95% CI: 3.87 to 5.17].

Discussion: Compared with patients with only HIV or diabetes, patients with both diagnoses are at significantly increased risk of progressive CKD even after adjusting for traditional CKD risk factors. Future studies should evaluate the relative contribution of complex comorbidities and accompanying polypharmacy to the risk of CKD in HIV-infected individuals and prospectively investigate the use of cART, glycemic control, and adjunctive therapy to delay CKD progression.

*Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY

Department of Medicine, Section of Nephrology, Yale University, New Haven, CT

Clinical Epidemiology Research Center, West Haven VA Medical Center, West Haven, CT

§Department of Medicine, Division of Infectious Diseases, James J. Peters VA Medical Center, Bronx, NY

Department of Medicine, Division of Infectious Diseases, Mount Sinai School of Medicine, New York, NY

Department of Medicine, Division of Infectious Diseases, VA Pittsburgh Healthcare System, Pittsburgh, PA

#Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA

**Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

††Department of Medicine, Division of Infectious Diseases, VA Medical Center, Washington, DC

‡‡Department of Medicine, Division of Infectious Diseases, George Washington University Medical Center, Washington, DC

§§Department of Medicine, Division of Infectious Diseases, VA Medical Center, Atlanta, GA

‖‖Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA

¶¶Department of Medicine, Section of Infectious Diseases, Michael E. DeBakey VA Medical Center, Houston, TX

##Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX

***Department of Medicine, University of Pittsburgh, Pittsburgh, PA

†††Department of Medicine, West Haven VA Medical Center, New Haven, CT

‡‡‡Department of Medicine, Yale University, New Haven, CT

§§§Department of Medicine, Division of Nephrology, James J. Peters VA Medical Center, Bronx, NY.

Correspondence to: Christina M. Wyatt, MD, Assistant Professor, Medicine and Nephrology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1243, New York, NY 10029 (e-mail: christina.wyatt@mssm.edu).

The authors have no funding or conflicts of interest to disclose.

Received January 30, 2012

Accepted April 19, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.