Institut National de la Santé et de la Recherche Médicale U897, Bordeaux, F-33076, France.
HIV Med. 2010 May;11(5):308-17. doi: 10.1111/j.1468-1293.2009.00780.x. Epub 2009 Dec 9.
The aims of the present study were to estimate the prevalence of renal impairment (RI) among HIV-infected adult patients and to investigate the associated factors.
A cross-sectional survey was conducted in a French hospital-based cohort. Clearance of creatinine (CC) was calculated using the Cockcroft-Gault formula. Four stages of RI were defined: mild (60-90 mL/min), moderate (30-60), severe (15-30) and end stage (<15). Logistic regression models were used to investigate factors associated with RI.
The male/female ratio of the 2588 patients enrolled was 3:1 and the median age was 42 years. At the time of assessment of CC, the median CD4 count was 430 cells/microL and HIV plasma viral load (VL) was<50 copies/mL in 60%. The overall prevalence of RI was 39.0%: 34.2% mild, 4.4% moderate, 0.3% severe and 0.2% end-stage. Mild RI was associated with female gender [odds ratio (OR)=3.3: 95% CI 2.6-4.3)], age >50 years (OR=9.8: 7.4-13.0) and 40-50 years (OR=1.9: 1.5-2.4), body mass index (BMI) <22 kg/m(2) (OR=3.3: 2.7-4.3) and tenofovir exposure (OR=1.4: 1.0-1.9 for <1 year and OR=1.5: 1.2-2.0 for >1 year). Advanced RI (CC <60 mL/min) was associated with age >50 years (OR=5.6: 2.9-10.9) and 40-50 years (OR=2.2: 1.1-1.4), BMI <22 kg/m(2) (OR=1.5: 1.0-2.4), hypertension (OR=2.5: 1.4-2.5) and indinavir (IDV) exposure >1 year (OR=2.3: 1.5-3.6).
This survey confirms the high prevalence of RI in HIV-infected patients and indicates the importance of the investigation of renal function especially in women, older patients, those with a low BMI or treated with tenofovir or IDV.
本研究旨在评估感染 HIV 的成年患者中肾功能损害（RI）的流行率，并探讨其相关因素。
本研究采用法国医院队列的横断面调查。采用 Cockcroft-Gault 公式计算肌酐清除率（CC）。将 RI 分为四个阶段：轻度（60-90 mL/min）、中度（30-60）、重度（15-30）和终末期（<15）。采用 logistic 回归模型探讨与 RI 相关的因素。
纳入的 2588 例患者中，男/女比例为 3:1，中位年龄为 42 岁。在评估 CC 时，中位 CD4 计数为 430 个细胞/μL，60%的患者 HIV 血浆病毒载量（VL）<50 拷贝/mL。RI 的总患病率为 39.0%：34.2%为轻度，4.4%为中度，0.3%为重度，0.2%为终末期。女性（比值比[OR] = 3.3：95%置信区间[CI] 2.6-4.3]）、年龄>50 岁（OR = 9.8：7.4-13.0）和 40-50 岁（OR = 1.9：1.5-2.4）、体重指数（BMI）<22 kg/m2（OR = 3.3：2.7-4.3）和使用替诺福韦（OR = 1.4：1.0-1.9，<1 年；OR = 1.5：1.2-2.0，>1 年）与轻度 RI 相关。晚期 RI（CC <60 mL/min）与年龄>50 岁（OR = 5.6：2.9-10.9）和 40-50 岁（OR = 2.2：1.1-1.4）、BMI<22 kg/m2（OR = 1.5：1.0-2.4）、高血压（OR = 2.5：1.4-2.5）和使用茚地那韦（IDV）>1 年（OR = 2.3：1.5-3.6）相关。
本调查证实了 HIV 感染患者 RI 的高患病率，并表明特别需要对女性、年龄较大的患者、BMI 较低或接受替诺福韦或 IDV 治疗的患者进行肾功能检查。
