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Deteriorating renal function and clinical outcomes in HIV-positive persons

(2014) AIDS. 28(5). p.727-737
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Abstract
Objectives: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU <= 60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality. Design: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA. Methods: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events. Results: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24). Conclusion: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.
Keywords
ALL-CAUSE, SERUM CREATININE, CYSTATIN C, chronic kidney disease, CARDIOVASCULAR EVENTS, INFECTED PATIENTS, NON-AIDS, MORTALITY RISK, mortality, GLOMERULAR-FILTRATION-RATE, non-AIDS, CHRONIC KIDNEY-DISEASE, estimated glomerular filtration rate, COMBINATION ANTIRETROVIRAL THERAPY, AIDS

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Chicago
Mocroft, Amanda, Lene Ryom, Josip Begovac, Antonella D’Arminio Monforte, Anne Vassilenko, Jose Gatell, Eric Florence, et al. 2014. “Deteriorating Renal Function and Clinical Outcomes in HIV-positive Persons.” Aids 28 (5): 727–737.
APA
Mocroft, A., Ryom, L., Begovac, J., Monforte, A. D., Vassilenko, A., Gatell, J., Florence, E., et al. (2014). Deteriorating renal function and clinical outcomes in HIV-positive persons. AIDS, 28(5), 727–737.
Vancouver
1.
Mocroft A, Ryom L, Begovac J, Monforte AD, Vassilenko A, Gatell J, et al. Deteriorating renal function and clinical outcomes in HIV-positive persons. AIDS. 2014;28(5):727–37.
MLA
Mocroft, Amanda et al. “Deteriorating Renal Function and Clinical Outcomes in HIV-positive Persons.” AIDS 28.5 (2014): 727–737. Print.
@article{5913787,
  abstract     = {Objectives: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU <= 60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality. Design: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA.
Methods: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events.
Results: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24).
Conclusion: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded.},
  author       = {Mocroft, Amanda and Ryom, Lene and Begovac, Josip and Monforte, Antonella D'Arminio and Vassilenko, Anne and Gatell, Jose and Florence, Eric and Ormaasen, Vidar and Kirk, Ole and Lundgren, Jens D and EuroSIDA EuroCOORD, the and Vandekerckhove, Linos},
  issn         = {0269-9370},
  journal      = {AIDS},
  keywords     = {ALL-CAUSE,SERUM CREATININE,CYSTATIN C,chronic kidney disease,CARDIOVASCULAR EVENTS,INFECTED PATIENTS,NON-AIDS,MORTALITY RISK,mortality,GLOMERULAR-FILTRATION-RATE,non-AIDS,CHRONIC KIDNEY-DISEASE,estimated glomerular filtration rate,COMBINATION ANTIRETROVIRAL THERAPY,AIDS},
  language     = {eng},
  number       = {5},
  pages        = {727--737},
  title        = {Deteriorating renal function and clinical outcomes in HIV-positive persons},
  url          = {http://dx.doi.org/10.1097/QAD.0000000000000134},
  volume       = {28},
  year         = {2014},
}

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