Advanced chronic kidney disease (CKD) has a relatively low prevalence among patients with HIV, but the prevalence is increasing, according to a recent study.
In addition, the study showed that a proportion of patients with advanced CKD in HIV have to start or resume nephrology care or eventually require renal replacement therapy.
Out of a cohort of 3090 individuals with HIV seen at a tertiary care hospital from June 2019 to June 2020, 55 (1.8%) met Kidney Disease Improving Global Outcomes (KDIGO) criteria for advanced CKD (stages 4 and 5), a nearly 4-fold increase from the 0.5% prevalence found in a previous study performed from 2008-2010, Anna Bonjoch, MD, PhD, of Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain, and colleagues reported in HIV Medicine. The increase in prevalence occurred despite the availability of new antiretroviral drugs with better renal safety profiles compared with previous drugs and improvements in kidney disease management in the past decade, according to the investigators.
“The explanation for the increasing prevalence of kidney disease could be multifactorial: aging of the population increases the possibility of kidney damage, and the high prevalence of cardiovascular risk factors among people living with HIV, namely arterial hypertension and dyslipidaemia, may also contribute,” the authors wrote.
During the 48-week follow-up, 7 patients (13%) had to start or resume follow-up with a nephrologist, 9 (16.4%) had an improvement in kidney disease stage, 3 (5.5%) received a kidney transplant, and 1 (2%) started hemodialysis.
The most frequent comorbidity was arterial hypertension (85.5%). The investigators identified inadequate antiretroviral dose in 3 patients (5.5%) and drug-drug interactions in 8 patients (14.5%). In addition, 4 patients (7%) required modification of their concomitant treatment.
“Our results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug-drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease,” Dr Bonjoch and colleagues concluded.
Bonjoch A, Juega J, Echeverría P, et al. Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV. HIV Med. Published online April 26, 2022. doi:10.1111/hiv.13317