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Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals

Woolnough, Emily L.a; Hoy, Jennifer F.a,b; Cheng, Allen C.a,b; Walker, Rowan G.b,c; Chrysostomou, Anastasiac; Woolley, Iana,b,d; Langham, Freyaa; Moso, Michael A.a; Weeraratne, Achinib; Trevillyan, Janine M.a,b

doi: 10.1097/QAD.0000000000001901

Objective: The current study aimed to validate existing risk prediction scores and identify predictors of chronic kidney disease (CKD) in the setting of HIV.

Design and methods: A retrospective cohort study of HIV-positive individuals (n = 748) with baseline estimated glomerular filtration rate (eGFR) more than 60 ml/min was conducted at the Alfred Hospital, Melbourne, Australia. Multivariable regression analysis was performed to determine factors associated with development of CKD, defined as two consecutive measurements of eGFR less than 60 ml/min. The performance of CKD risk scores proposed by the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group and Scherzer and colleagues were estimated by the area under the receiver operator curve (AUROC).

Results: CKD developed in 37 individuals (5.0%), at a median of 4.7 (interquartile range 2.2, 6.2) years. Older age [odds ratio (OR) 3.03, 95% confidence interval (CI): 1.20, 7.65, P = 0.02] and lower baseline eGFR (OR 10.39, 95% CI: 4.73, 22.83, P < 0.001) were associated with the development of CKD. Neither current, nor cumulative tenofovir disoproxil fumarate (TDF) use was associated with progression to CKD [current TDF hazard ratio (HR) 1.05, 95% CI: 0.54, 2.07, P = 0.88; cumulative TDF HR 1.03, 95% CI: 0.86, 1.24, P = 0.75]. The short D:A:D and Scherzer scores were well calibrated, with the short D:A:D score demonstrating superior discrimination (short D:A:D AUROC 0.85, Scherzer AUROC 0.78, P = 0.02).

Conclusion: Older individuals and those with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk, who may benefit from aggressive management of risk factors.

aDepartment of Infectious Diseases, Alfred Hospital

bFaculty of Medicine, Nursing and Health Sciences, Monash University

cDepartment of Renal Medicine, Alfred Hospital

dDepartment of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.

Correspondence to Dr Janine M. Trevillyan, MBBS, FRACP, PhD, Department of Infectious Diseases, Alfred Hospital and Monash University, 55 Commercial Rd, Melbourne 3004, VIC, Australia. Tel: +61 3 9076 6000; fax: +61 3 9076 6557; e-mail:

Received 7 January, 2018

Revised 29 April, 2018

Accepted 30 April, 2018

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Copyright © 2018 Wolters Kluwer Health, Inc.