IAS 2013: End-Stage Kidney Disease Is More Common Among People with HIV

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HIV positive people in the U.S. and Canada are nearly 4 times as likely to develop end-stage renal disease than HIV negative people in the general population, largely driven by a very high rate among blacks, researchers reported last month at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur.

Over the course of the epidemic numerous studies have reported higher rates of kidney problems among people with HIV, but it is not yet clear whether this is due to HIV infection itself, resulting metabolic or inflammatory changes, toxicities of antiretroviral drugs, or some combination of factors. Studies to date -- some done before the advent of effective antiretroviral therapy (ART) -- have produced widely varying kidney disease incidence rates.

Keri Althoff from Johns Hopkins and colleagues looked at the incidence of end-stage renal disease (ESRD) -- defined by the need for dialysis or kidney transplantation -- in the large North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) population.

The investigators identified HIV positive individuals in 12 NA-ACCORD cohorts -- together including 37,801 participants -- who had 2 or more estimated glomerular filtration rate (eGFR) measurements <30 mL/min taken at least 90 days apart or a diagnosis of kidney disease between January 2000 and December 2009.

Overall, about 80% of study participants were men, about 40% were white, about one-third were black, and about 25% were age 50 or older. Male sex, black race, and older age are known kidney disease risk factors. Approximately 20% had CD4 T-cell counts below 200 cells/mm3 and another 20% between 200-350 cells/mm3.

Results

"The overall estimated incidence of ESRD in the NA-ACCORD is higher than estimates from Europe [121 per 100,000 PY in EuroSIDA], and lower than estimates from the Veteran’s Aging Cohort Study [300 per 100,000 PY]," the researchers concluded. "These differences are likely attributed to the differences in age, race, sex, and risk factor composition of these populations."

While the finding that women had a higher rate of ESRD is contrary to what is usually seen in the general population, the investigators said this was likely attributable to the fact that a higher proportion of HIV positive women are black. After adjusting for demographics and HIV-related characteristics, there was no longer a difference by sex.

Having an undetectable HIV viral load lowered the risk of ESRD by 42%, underlining the importance of treatment.

They added that more research is needed looking at additional kidney disease risk factors such as smoking, hepatitis C infection, and diabetes.

8/7/13

Reference

K Althoff, A Abraham, M Estrella, et al. Incidence of end stage renal disease in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013. Abstract MOPE082.