HIV Patients at Higher Risk of Needing Renal Replacement Therapy

HIV patients, who are at increased risk of impaired renal function, are much more likely to be placed on renal replacement therapy (RRT) than the general population, a Danish study found.

In a nationwide, population-based cohort study that included 5,300 HIV patients and 53,000 population controls, Magnus G. Rasch, MD, of the University of Copenhagen, and colleagues found that HIV patients had a fourfold increased risk of any RRT (aRRT) and a threefold increased risk of chronic RRT (cRRT) compared with age- and gender-matched controls, according to findings published online ahead of print in Nephrology Dialysis Transplantation.

The risk of aRRT was highest in the first year after HIV diagnosis.

Among the HIV patients, intravenous drug use and hypertension were associated with a sixfold and sevenfold increased risk of aRRT, respectively. Hypertension was associated with a 19 times increased risk of cRRT. Those with an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2 had a nearly eightfold increased risk.

Although previous studies have shown that exposure to the antiretrovirals tenofovir and atazanavir is associated with deterioration of renal function, these agents alone or in combination were not associated with aRRT or cRRT in the new study, the researchers reported.

Dr. Rasch's group noted that tenofovir was introduced in 2001 and the first case report of acute renal failure associated with exposure to the drug was published in 2002. Studies have demonstrated an association between exposure to tenofovir and a decline in eGFR and an increased risk of chronic kidney disease.

“The lack of association between tenofovir and aRRT/cRRT in the present study may be due to the fact that clinicians, knowing the nephrotoxic effects of tenofovir, discontinued the drug in patients who developed mild-to-moderate impairment in renal function and thereby prevented further decrease in renal function and descent to renal failure,” the authors wrote.

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