Zachor Hadas, Machekano Rhoderick, Estrella Michelle M, Veldkamp Peter J, Zeier Michele D, Uthman Olalekan A, Taljaard Jantjie J, Moosa Mohammed R, Nachega Jean B
aDepartment of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA bBiostatistics Unit, Stellenbosch University, Cape Town, South Africa cDepartment of Medicine, Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA dDepartment of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences eCentre for Evidence-Based Healthcare; Stellenbosch University, Cape Town, South Africa fDivision of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, UK gDepartment of Medicine, Division of Nephrology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa hDepartments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania iDepartments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
AIDS. 2016 May 15;30(8):1221-8. doi: 10.1097/QAD.0000000000001041.
To describe the incidence of rapid kidney function decline (RKFD), and stage 3 chronic kidney disease (CKD) in HIV-1-infected adults initiated on tenofovir-containing antiretroviral therapy.
A retrospective cohort study at the infectious diseases clinic of Tygerberg Academic Hospital in Cape Town, South Africa. Patients with more than 3 ml/min per year decline in estimated glomerular filtration were classified as having RKFD, and stage 3 CKD was defined as a value less than 60 ml/min per 1.73 m. We used logistic and Cox proportional hazards regression models to determine factors associated with RKFD and stage 3 CKD.
Of 650 patients, 361 (55%) experienced RKFD and 15 (2%) developed stage 3 CKD during a median interquartile range follow-up time of 54 (46.6-98) weeks. For every 10-year increase in age and 10 ml/min lower baseline estimated glomerular filtration, the odds of RKFD increased by 70% [adjusted odds ratio = 1.70, 95% confidence interval (CI) 1.36-2.13] and 57% (adjusted odds ratio = 1.57, 95% CI 1.38-1.80), respectively. Each 10-year older age was associated with a 1.90-fold increased risk of developing stage 3 CKD (adjusted hazard ratio = 1.90, 95% CI: 1.10-3.29). Women had about four-fold greater risk of stage 3 CKD compared with men (adjusted hazard ratio = 3.96, 95% CI: 1.06-14.74).
About half of our study population developed RKFD but only 2% progressed to stage 3 CKD. Approaches that provide balanced allocation of limited resources toward screening and monitoring for kidney dysfunction and HIV disease management are critically needed in this setting.
描述开始接受含替诺福韦的抗逆转录病毒治疗的HIV-1感染成人中肾功能快速下降（RKFD）和3期慢性肾脏病（CKD）的发生率。
在南非开普敦泰格堡学术医院传染病诊所进行的一项回顾性队列研究。估计肾小球滤过率每年下降超过3 ml/min的患者被归类为患有RKFD，3期CKD定义为每1.73平方米低于60 ml/min。我们使用逻辑回归和Cox比例风险回归模型来确定与RKFD和3期CKD相关的因素。
在650例患者中，361例（55%）出现RKFD，15例（2%）在中位四分位间距随访时间54（46.6 - 98）周内发展为3期CKD。年龄每增加10岁以及基线估计肾小球滤过率每降低10 ml/min，RKFD的几率分别增加70%[调整优势比 = 1.70, 95%置信区间（CI）1.36 - 2.13]和57%（调整优势比 = 1.57, 95% CI 1.38 - 1.80）。年龄每增加10岁，发展为3期CKD的风险增加1.90倍（调整风险比 = 1.90, 95% CI: 1.10 - 3.29）。女性发生3期CKD的风险是男性的约4倍（调整风险比 = 3.96, 95% CI: 1.06 - 14.74）。
我们研究人群中约一半出现RKFD，但只有2%进展为3期CKD。在这种情况下，迫切需要采取方法，在筛查和监测肾功能障碍以及HIV疾病管理方面平衡分配有限资源。
