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Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care

To examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Multi... Full description

Journal Title: AIDS (London) 2012, Vol.26 (15), p.1907-1915
Main Author: KALAYJIAN, Robert C
Other Authors: LAU, Bryan , ERON, Joseph J , KITAHATA, Mari M , MECHEKANO, Rhoderick N , CRANE, Heidi M , RODRIGUEZ, Benigno , SALATA, Robert A , KRISHNASAMI, Zipporah , WILLIG, James H , MARTIN, Jeffrey N , MOORE, Richard D
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Hagerstown, MD: Lippincott Williams & Wilkins
ID: ISSN: 0269-9370
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3531628
title: Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care
format: Article
creator:
  • KALAYJIAN, Robert C
  • LAU, Bryan
  • ERON, Joseph J
  • KITAHATA, Mari M
  • MECHEKANO, Rhoderick N
  • CRANE, Heidi M
  • RODRIGUEZ, Benigno
  • SALATA, Robert A
  • KRISHNASAMI, Zipporah
  • WILLIG, James H
  • MARTIN, Jeffrey N
  • MOORE, Richard D
subjects:
  • Acquired immune deficiency syndrome
  • Adenine - adverse effects
  • Adenine - analogs & derivatives
  • Adult
  • AIDS-Associated Nephropathy - diagnosis
  • AIDS-Associated Nephropathy - epidemiology
  • Anti-HIV Agents - administration & dosage
  • Anti-HIV Agents - adverse effects
  • Antibiotics. Antiinfectious agents. Antiparasitic agents
  • Antiretroviral agents
  • antiretroviral therapy
  • Antiviral agents
  • Article
  • Biological and medical sciences
  • CD4 antigen
  • CD4 Lymphocyte Count
  • chronic kidney disease
  • Cohort Studies
  • Creatinine
  • Creatinine - blood
  • Epidermal growth factor receptors
  • Female
  • Filtration
  • Glomerular Filtration Rate
  • Hepatitis
  • Hepatitis C
  • Hepatitis C - diagnosis
  • Hepatitis C - drug therapy
  • Hepatitis C - epidemiology
  • HIV Seropositivity - diagnosis
  • HIV Seropositivity - drug therapy
  • HIV Seropositivity - epidemiology
  • HIV-1
  • Human immunodeficiency virus 1
  • Human viral diseases
  • Humans
  • Incidence
  • Infectious diseases
  • Kidney
  • Kidney diseases
  • Kidneys
  • Long-term effects
  • Male
  • Medical sciences
  • Middle Aged
  • Nephrology. Urinary tract diseases
  • Organophosphonates - adverse effects
  • Pharmacology. Drug treatments
  • Proportional Hazards Models
  • Proteinase inhibitors
  • Renal function
  • Renal Insufficiency, Chronic - chemically induced
  • Renal Insufficiency, Chronic - diagnosis
  • Renal Insufficiency, Chronic - epidemiology
  • Renal Insufficiency, Chronic - etiology
  • Risk Factors
  • Ritonavir - administration & dosage
  • Tenofovir
  • United States - epidemiology
  • Urinary system involvement in other diseases. Miscellaneous
  • Viral diseases
  • Viral diseases of the lymphoid tissue and the blood. Aids
  • Viral Load - drug effects
ispartof: AIDS (London), 2012, Vol.26 (15), p.1907-1915
description: To examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes. Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from -2.18 to -1.37 ml/min per 1.73 m per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold
language: eng
source:
identifier: ISSN: 0269-9370
fulltext: no_fulltext
issn:
  • 0269-9370
  • 1473-5571
url: Link


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titleRisk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care
creatorKALAYJIAN, Robert C ; LAU, Bryan ; ERON, Joseph J ; KITAHATA, Mari M ; MECHEKANO, Rhoderick N ; CRANE, Heidi M ; RODRIGUEZ, Benigno ; SALATA, Robert A ; KRISHNASAMI, Zipporah ; WILLIG, James H ; MARTIN, Jeffrey N ; MOORE, Richard D
creatorcontribKALAYJIAN, Robert C ; LAU, Bryan ; ERON, Joseph J ; KITAHATA, Mari M ; MECHEKANO, Rhoderick N ; CRANE, Heidi M ; RODRIGUEZ, Benigno ; SALATA, Robert A ; KRISHNASAMI, Zipporah ; WILLIG, James H ; MARTIN, Jeffrey N ; MOORE, Richard D
descriptionTo examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes. Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from -2.18 to -1.37 ml/min per 1.73 m per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold <60 ml/min per 1.73 m: 3.35 (95% confidence interval (CI) = 1.40-8.02)], which developed in 5.7% of patients after 4 years of exposure to this regimen-type. ART was associated with reduced CKD risk in association with CD4 cell restoration and plasma viral load suppression, despite an increased CKD risk that was associated with initial regimens that included tenofovir and rPI.
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subjectAcquired immune deficiency syndrome ; Adenine - adverse effects ; Adenine - analogs & derivatives ; Adult ; AIDS-Associated Nephropathy - diagnosis ; AIDS-Associated Nephropathy - epidemiology ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - adverse effects ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral agents ; antiretroviral therapy ; Antiviral agents ; Article ; Biological and medical sciences ; CD4 antigen ; CD4 Lymphocyte Count ; chronic kidney disease ; Cohort Studies ; Creatinine ; Creatinine - blood ; Epidermal growth factor receptors ; Female ; Filtration ; Glomerular Filtration Rate ; Hepatitis ; Hepatitis C ; Hepatitis C - diagnosis ; Hepatitis C - drug therapy ; Hepatitis C - epidemiology ; HIV Seropositivity - diagnosis ; HIV Seropositivity - drug therapy ; HIV Seropositivity - epidemiology ; HIV-1 ; Human immunodeficiency virus 1 ; Human viral diseases ; Humans ; Incidence ; Infectious diseases ; Kidney ; Kidney diseases ; Kidneys ; Long-term effects ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Organophosphonates - adverse effects ; Pharmacology. Drug treatments ; Proportional Hazards Models ; Proteinase inhibitors ; Renal function ; Renal Insufficiency, Chronic - chemically induced ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - epidemiology ; Renal Insufficiency, Chronic - etiology ; Risk Factors ; Ritonavir - administration & dosage ; Tenofovir ; United States - epidemiology ; Urinary system involvement in other diseases. Miscellaneous ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Viral Load - drug effects
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0KALAYJIAN, Robert C
1LAU, Bryan
2ERON, Joseph J
3KITAHATA, Mari M
4MECHEKANO, Rhoderick N
5CRANE, Heidi M
6RODRIGUEZ, Benigno
7SALATA, Robert A
8KRISHNASAMI, Zipporah
9WILLIG, James H
10MARTIN, Jeffrey N
11MOORE, Richard D
title
0Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care
1AIDS (London)
addtitleAIDS
descriptionTo examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes. Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from -2.18 to -1.37 ml/min per 1.73 m per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold <60 ml/min per 1.73 m: 3.35 (95% confidence interval (CI) = 1.40-8.02)], which developed in 5.7% of patients after 4 years of exposure to this regimen-type. ART was associated with reduced CKD risk in association with CD4 cell restoration and plasma viral load suppression, despite an increased CKD risk that was associated with initial regimens that included tenofovir and rPI.
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0Acquired immune deficiency syndrome
1Adenine - adverse effects
2Adenine - analogs & derivatives
3Adult
4AIDS-Associated Nephropathy - diagnosis
5AIDS-Associated Nephropathy - epidemiology
6Anti-HIV Agents - administration & dosage
7Anti-HIV Agents - adverse effects
8Antibiotics. Antiinfectious agents. Antiparasitic agents
9Antiretroviral agents
10antiretroviral therapy
11Antiviral agents
12Article
13Biological and medical sciences
14CD4 antigen
15CD4 Lymphocyte Count
16chronic kidney disease
17Cohort Studies
18Creatinine
19Creatinine - blood
20Epidermal growth factor receptors
21Female
22Filtration
23Glomerular Filtration Rate
24Hepatitis
25Hepatitis C
26Hepatitis C - diagnosis
27Hepatitis C - drug therapy
28Hepatitis C - epidemiology
29HIV Seropositivity - diagnosis
30HIV Seropositivity - drug therapy
31HIV Seropositivity - epidemiology
32HIV-1
33Human immunodeficiency virus 1
34Human viral diseases
35Humans
36Incidence
37Infectious diseases
38Kidney
39Kidney diseases
40Kidneys
41Long-term effects
42Male
43Medical sciences
44Middle Aged
45Nephrology. Urinary tract diseases
46Organophosphonates - adverse effects
47Pharmacology. Drug treatments
48Proportional Hazards Models
49Proteinase inhibitors
50Renal function
51Renal Insufficiency, Chronic - chemically induced
52Renal Insufficiency, Chronic - diagnosis
53Renal Insufficiency, Chronic - epidemiology
54Renal Insufficiency, Chronic - etiology
55Risk Factors
56Ritonavir - administration & dosage
57Tenofovir
58United States - epidemiology
59Urinary system involvement in other diseases. Miscellaneous
60Viral diseases
61Viral diseases of the lymphoid tissue and the blood. Aids
62Viral Load - drug effects
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1LAU, Bryan
2ERON, Joseph J
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6RODRIGUEZ, Benigno
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titleRisk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care
authorKALAYJIAN, Robert C ; LAU, Bryan ; ERON, Joseph J ; KITAHATA, Mari M ; MECHEKANO, Rhoderick N ; CRANE, Heidi M ; RODRIGUEZ, Benigno ; SALATA, Robert A ; KRISHNASAMI, Zipporah ; WILLIG, James H ; MARTIN, Jeffrey N ; MOORE, Richard D
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0Acquired immune deficiency syndrome
1Adenine - adverse effects
2Adenine - analogs & derivatives
3Adult
4AIDS-Associated Nephropathy - diagnosis
5AIDS-Associated Nephropathy - epidemiology
6Anti-HIV Agents - administration & dosage
7Anti-HIV Agents - adverse effects
8Antibiotics. Antiinfectious agents. Antiparasitic agents
9Antiretroviral agents
10antiretroviral therapy
11Antiviral agents
12Article
13Biological and medical sciences
14CD4 antigen
15CD4 Lymphocyte Count
16chronic kidney disease
17Cohort Studies
18Creatinine
19Creatinine - blood
20Epidermal growth factor receptors
21Female
22Filtration
23Glomerular Filtration Rate
24Hepatitis
25Hepatitis C
26Hepatitis C - diagnosis
27Hepatitis C - drug therapy
28Hepatitis C - epidemiology
29HIV Seropositivity - diagnosis
30HIV Seropositivity - drug therapy
31HIV Seropositivity - epidemiology
32HIV-1
33Human immunodeficiency virus 1
34Human viral diseases
35Humans
36Incidence
37Infectious diseases
38Kidney
39Kidney diseases
40Kidneys
41Long-term effects
42Male
43Medical sciences
44Middle Aged
45Nephrology. Urinary tract diseases
46Organophosphonates - adverse effects
47Pharmacology. Drug treatments
48Proportional Hazards Models
49Proteinase inhibitors
50Renal function
51Renal Insufficiency, Chronic - chemically induced
52Renal Insufficiency, Chronic - diagnosis
53Renal Insufficiency, Chronic - epidemiology
54Renal Insufficiency, Chronic - etiology
55Risk Factors
56Ritonavir - administration & dosage
57Tenofovir
58United States - epidemiology
59Urinary system involvement in other diseases. Miscellaneous
60Viral diseases
61Viral diseases of the lymphoid tissue and the blood. Aids
62Viral Load - drug effects
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abstractTo examine long-term effects of antiretroviral therapy (ART) on kidney function, we evaluated the incidence and risk factors for chronic kidney disease (CKD) among ART-naive, HIV-infected adults and compared changes in estimated glomerular filtration rates (eGFR) before and after starting ART. Multicenter observational cohort study of patients with at least one serum creatinine measurement before and after initiating ART. Cox proportional hazard models, and marginal structure models examined CKD risk factors; mixed-effects linear models examined eGFR slopes. Three thousand, three hundred and twenty-nine patients met entry criteria, contributing 10 099 person-years of observation on ART. ART was associated with a significantly slower rate of eGFR decline (from -2.18 to -1.37 ml/min per 1.73 m per year; P = 0.02). The incidence of CKD defined by eGFR thresholds of 60, 45 and 30 ml/min per 1.73 m was 10.5, 3.4 and 1.6 per 1000 person-years, respectively. In adjusted analyses black race, hepatitis C coinfection, lower time-varying CD4 cell count and higher time-varying viral load on ART were associated with higher CKD risk, and the magnitude of these risks increased with more severe CKD. Tenofovir and a ritonavir-boosted protease inhibitor (rPI) was also associated with higher CKD risk [hazard odds ratio for an eGFR threshold <60 ml/min per 1.73 m: 3.35 (95% confidence interval (CI) = 1.40-8.02)], which developed in 5.7% of patients after 4 years of exposure to this regimen-type. ART was associated with reduced CKD risk in association with CD4 cell restoration and plasma viral load suppression, despite an increased CKD risk that was associated with initial regimens that included tenofovir and rPI.
copHagerstown, MD
pubLippincott Williams & Wilkins
pmid22824630
doi10.1097/QAD.0b013e328357f5ed
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