Journal
AIDS
Volume 33, Issue 14, Pages 2173-2188Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0000000000002331
Keywords
chronic kidney disease; chronic kidney disease; HIV; modifiable risk factors; prognosis; renal; serious clinical events
Categories
Funding
- Highly Active Antiretroviral Therapy Oversight Committee (HAART-OC)
- Danish National Research Foundation (CHIP) [DNRF126]
- Dutch Ministry of Health, Welfare and Sport through the Center for Infectious Disease Control of the National Institute for Public Health and the Environment
- Agence nationale de recherches sur le sida et les hepatites virales (ANRS) [7]
- Asia Pacific HIV Observational Database, a program of The Foundation for AIDS Research, amfAR
- U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) [U01-AI069907]
- Merck Sharp Dohme
- Gilead Sciences
- Bristol-Myers Squibb
- Boehringer Ingelheim
- Janssen-Cilag
- ViiV Healthcare
- Australian Government Department of Health and Ageing
- Faculty of Medicine, The University of New South Wales
- Fondo de Investigacion Sanitaria [FIS 99/0887]
- Fundacion para la Investigacion y la Prevencion del SIDA en Espana [FIPSE 3171/00]
- National Institute of Allergy and Infectious Diseases, National Institutes of Health [5U01AI042170-10, 5U01AI046362-03]
- European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant [260694]
- Janssen RD
- Merck and Co. Inc.
- Pfizer Inc.
- GlaxoSmithKline LLC [Swiss National Science Foundation] [108787]
- AbbVie
- GlaxoSmithKline
- Pfizer
- Janssen Pharmaceuticals
- Swiss National Science Foundation [148522]
- Danish National Research Foundation (PERSIMUNE) [DNRF126]
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Objectives: Predictors of chronic kidney disease (CKD) amongst HIV-positive persons are well established, but insights into the prognosis after CKD including the role of modifiable risk factors are limited. Design: Prospective cohort study. Methods: D:A:D participants developing CKD (confirmed, >3 months apart, eGFR <= 60 ml/min per 1.73 m 2 or 25% eGFR decrease when eGFR <= 60 ml/min per 1.73 m(2)) were followed to incident serious clinical events (SCE); end stage renal and liver disease (ESRL and ESLD), cardiovascular disease (CVD), AIDS-defining and non-AI DS-defining malignancies (NADM), other AIDS or death, 6 months after last visit or 1 February 2016. Poisson regression models considered associations between SCE and modifiable risk factors. Results: During 2.7 (IQR 1.1-5.1) years median follow-up 595 persons with CKD (24.1%) developed a SCE [incidence rate 68.9/1000 PYFU (95% confidence interval 63.4-74.4)] with 8.3% (6.9-9.0) estimated to experience any SCE at 1 year. The most common SCE was death (12.7%), followed by NADM (5.8%), CVD (5.6%), other AIDS (5.0%) and ESRD (2.9%). Crude SCE ratios were significantly higher in those with vs. without CKD, strongest for ESRD [65.9 (43.8-100.9)] and death [4.8 (4.3-5.3)]. Smoking was consistently associated with all CKD-related SCE. Diabetes predicted CVD, NADM and death, whereas dyslipidaemia was only significantly associated with CVD. Poor HIV-status predicted other AIDS and death, eGFR less than 30 ml/min per 1.73 m(2) predicted CVD and death and low BMI predicted other AIDS and death. Conclusion: In an era where many HIV-positive persons require less monitoring because of efficient antiretroviral treatment, persons with CKD carry a high burden of SCE. Several potentially modifiable risk factors play a central role for CKD-related morbidity and mortality. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.
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