14th Annual Conference of the British HIV Association 23–25 April 2008, Belfast

CHRONIC KIDNEY DISEASE IN HIV-INFECTED PATIENTS

HIV Med 2008 Apr 23-25 (Suppl 1);14:5 (abstract no. O18)

FA Post¹, Ms LJ Campbell¹, F Ibrahim¹, M Fisher², SG Holt² and BM Hendry^2
1King’s College London, UK, ²Brighton and Sussex University Hospital, Brighton, UK

DISCUSSION: While chronic kidney disease (CKD) is an important complication of HIV infection, the contribution of non-primary renal diagnoses and antiretroviral therapy to the burden of CKD remains to be defined.

METHODS: Patients with CKD (estimated glomerular filtration rate [eGFR] <60 mL/min for >3 months) were identified among 3439 HIV-infected outpatients who attended two UK clinics between 1/1998 and 12/2005. Prevalence and aetiology of CKD were defined, factors associated with CKD identified, and the effect of indinavir (IDV) and tenofovir (TNF) on renal function assessed.

RESULTS: The prevalence of CKD was 2.4% (95% CI 2.1%-2.7%). Primary renal diagnoses accounted for 65% of CKD in black compared to 9% in non-black (predominantly Caucasian) patients (p<0.001). Compared to primary CKD, patients with non-primary CKD (associated with metabolic, vascular disease and/or drug toxicity) had less severe renal impairment (p<0.001) and reduced progression to end-stage CKD (p<0.001). Compared to patients without CKD, more patients with non-primary CKD had received IDV (25% versus 7%, p<0.001) or TNF (45% versus 29%, p=0.005). The majority of patients who developed CKD associated with IDV or TNF had additional risk factors. Age >50 years was associated with CKD among patients initiating IDV, and age >50 years, eGFR <90 mL/ min, and duration of prior antiretroviral therapy with CKD among patients who initiated TNF.

CONCLUSIONS: Non-primary renal disease accounted for >90% of CKD in Caucasians. The risk of non-primary CKD in patients initiating IDV or TNF is modified by the presence of other risk factors for CKD, age and, for TNF, renal function and duration of prior antiretroviral treatment.

2008-04-23
O18

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