TY - JOUR
T1 - Prevalence and factors associated with renal dysfunction among HIV-infected patients
AU - Crum-Cianflone, Nancy
AU - Ganesan, Anuradha
AU - Teneza-Mora, Nimfa
AU - Riddle, Mark
AU - Medina, Sheila
AU - Barahona, Irma
AU - Brodine, Stephanie
PY - 2010/6/1
Y1 - 2010/6/1
N2 - Renal dysfunction is an increasingly recognized non-AIDS-defining comorbidity among HIV-infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate (GFR)<60mL/min/1.73m2. We evaluated 717 HIV patients with a median age of 41 years; 92% were male, 49% Caucasian, and 38% African American; median CD4 count was 515cells/mm 3 and 73% were receiving highly active antiretroviral therapy (HAART). Twenty-two patients (3%) had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age (odds ratio [OR] 2.0 per 10 year increase, p=0.006), lower CD4 nadir (OR 0.6 per 100cell change, p=0.02), and duration of tenofovir use (OR 1.5 per year use, p=0.01). Among persons initiating tenofovir (n=241), 50% experienced a reduction in GFR (median -10.5mL/min/1.73m2, 95% CI, -8.9 to -13.3) within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender (p<0.001), African American ethnicity (p=0.003), and lower CD4 nadir (p=0.002). In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir <200cells/mm3. Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.
AB - Renal dysfunction is an increasingly recognized non-AIDS-defining comorbidity among HIV-infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate (GFR)<60mL/min/1.73m2. We evaluated 717 HIV patients with a median age of 41 years; 92% were male, 49% Caucasian, and 38% African American; median CD4 count was 515cells/mm 3 and 73% were receiving highly active antiretroviral therapy (HAART). Twenty-two patients (3%) had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age (odds ratio [OR] 2.0 per 10 year increase, p=0.006), lower CD4 nadir (OR 0.6 per 100cell change, p=0.02), and duration of tenofovir use (OR 1.5 per year use, p=0.01). Among persons initiating tenofovir (n=241), 50% experienced a reduction in GFR (median -10.5mL/min/1.73m2, 95% CI, -8.9 to -13.3) within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender (p<0.001), African American ethnicity (p=0.003), and lower CD4 nadir (p=0.002). In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir <200cells/mm3. Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.
UR - http://www.scopus.com/inward/record.url?scp=77954189876&partnerID=8YFLogxK
U2 - 10.1089/apc.2009.0326
DO - 10.1089/apc.2009.0326
M3 - Article
C2 - 20515419
AN - SCOPUS:77954189876
SN - 1087-2914
VL - 24
SP - 353
EP - 360
JO - AIDS Patient Care and STDs
JF - AIDS Patient Care and STDs
IS - 6
ER -