Copenhagen HIV Programme, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
HIV Med. 2013 Sep;14(8):503-8. doi: 10.1111/hiv.12038. Epub 2013 Apr 16.
Knowledge about advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD/ESRD and renal death.
Advanced CKD was defined as confirmed (two consecutive measurements ≥ 3 months apart) estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m(2) using Cockcroft-Gault, and ESRD as haemodialysis or peritoneal dialysis for ≥ 1 month or renal transplant. Renal death was death with renal disease as the underlying cause, using Coding Causes of Death in HIV (CoDe) methodology. Follow-up was from 1 January 2004 until last eGFR measurement, advanced CKD, ESRD or renal death, whichever occurred first. Poisson regression was used to identify predictors.
Of 9044 individuals included in the study, 58 (0.64%) experienced advanced CKD/ESRD/renal death [incidence rate 1.32/1000 person-years of follow-up (PYFU); 95% confidence interval (CI) 0.98-1.66]; 52% of those who experienced the endpoint had a baseline eGFR ≤ 60 mL/min/1.73 m(2) compared with 3% of those who did not. Using Kaplan-Meier methods, at 6 years from baseline, 0.83% (95% CI 0.59-1.07%) were estimated to have experienced the endpoint overall and 11.26% (95% CI 6.75-15.78%) among those with baseline eGFR ≤ 60 mL/min/1.73 m(2) . Independent predictors of the endpoint included any cardiovascular event [incidence rate ratio (IRR) 2.16; 95% CI 1.24-3.77], lower eGFR (IRR 0.64 per 5 mL/min/1.73 m(2) ; 95% CI 0.59-0.70) and lower CD4 count (IRR 0.77 per doubling; 95% CI 0.62-0.95). One year after experiencing advanced CKD or ESRD, an estimated 19.21% (95% CI 7.84-30.58%) of patients had died, mostly from extra-renal causes.
The incidence of advanced CKD/ESRD/renal death was low and predictors included traditional renal risk factors, HIV-related factors and pre-existing renal impairment. The prognosis following advanced CKD/ESRD was poor. Larger studies should address possible contributions of specific antiretrovirals.
有关艾滋病毒阳性患者晚期慢性肾脏病（CKD）和终末期肾病（ESRD）的知识有限。本研究的目的是调查晚期 CKD/ESRD 和肾脏死亡的发生率、预测因素和结局。
晚期 CKD 的定义为使用 Cockcroft-Gault 法两次连续测量间隔≥3 个月的确诊（eGFR）≤30mL/min/1.73m2，ESRD 定义为血液透析或腹膜透析≥1 个月或肾移植。肾脏死亡是指使用 HIV 编码死因（CoDe）方法将肾脏疾病作为根本原因的死亡。随访从 2004 年 1 月 1 日开始，直至首次出现 eGFR 检测值、晚期 CKD、ESRD 或肾脏死亡。采用泊松回归确定预测因素。
在纳入研究的 9044 名患者中，58 名（0.64%）发生了晚期 CKD/ESRD/肾脏死亡[发生率为 1.32/1000 人年随访（PYFU）；95%置信区间（CI）为 0.98-1.66]；52%发生终点事件的患者基线时 eGFR≤60mL/min/1.73m2，而未发生终点事件的患者中仅为 3%。Kaplan-Meier 方法显示，从基线开始 6 年时，总体估计有 0.83%（95%CI 0.59-1.07%）发生终点事件，而基线时 eGFR≤60mL/min/1.73m2的患者中估计有 11.26%（95%CI 6.75-15.78%）。终点事件的独立预测因素包括任何心血管事件[发病率比（IRR）2.16；95%CI 1.24-3.77]、较低的 eGFR（IRR 每 5mL/min/1.73m2下降 0.64；95%CI 0.59-0.70）和较低的 CD4 计数（IRR 每增加一倍下降 0.77；95%CI 0.62-0.95）。在发生晚期 CKD 或 ESRD 后 1 年，估计有 19.21%（95%CI 7.84-30.58%）的患者死亡，主要死于肾外原因。
晚期 CKD/ESRD/肾脏死亡的发生率较低，预测因素包括传统的肾脏危险因素、与 HIV 相关的因素和已存在的肾脏损害。晚期 CKD/ESRD 后的预后较差。应开展更大规模的研究以确定特定抗逆转录病毒药物的可能作用。
