Juega-Mariño Javier, Bonjoch Anna, Pérez-Alvarez Nuria, Negredo Eugenia, Bayes Beatriu, Bonet Josep, Clotet Buenaventura, Romero Ramon
Servicio de Nefrología, Hospital Germans Trias i Pujol, Badalona Universitat Autónoma de Barcelona Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona Universitat de Vic-Universitat Central de Catalunya, Barcelona IrsiCaixa Foundation, Badalona, Spain.
Medicine (Baltimore). 2017 Sep;96(37):e7421. doi: 10.1097/MD.0000000000007421.
Prevalence of kidney disease (KD) is increasing among human immunodeficiency virus (HIV)-infected population. Different factors have been related, varying on different published series.The objectives were to study prevalence of KD in those patients, its evolution, and associated risk factors.An observational cohort study of 1596 HIV-positive patients with cross-sectional data collection in 2008 and 2010 was conducted. We obtained clinical and laboratory markers, and registered previous or current treatment with tenofovir (TDF) and indinavir (IDV). The sample was divided according to estimated glomerular filtration rate (eGFR) by modification of diet in renal disease (MDRD) equation. Group 1: eGFR ≤60 mL/min/1.73 m; group 2: eGFR >60 mL/min/1.73 m.Among the patients, 76.4% were men, mean age (SD) 45 ± 9 years, time since diagnose of HIV 14 ± 7 years, and 47.2% of the patients received previous treatment with TDF and 39.1% with IDV. In 2008, eGFR ≤60: 4.9% (91.4% of them in chronic kidney disease [CKD] stage 3, eGFR 59-30 mL/min); this group was older, presented higher fibrinogen levels, and more patients were treated previously with TDF and IDV. In 2010, eGFR ≤60: 3.9% (87.1% stage 3 CKD). The 2.4% of cohort showed renal improvement and 1.3% decline of renal function over time. The absence of hypertension and treatment with TDF were associated with improvement in eGFR. Increased age, elevated fibrinogen, decreased albumin, diabetes mellitus, hyperTG, and worse virological control were risk factors for renal impairment.The HIV-positive patients in our area have a CKD prevalence of 4% to 5% (90% stage 3 CKD) associated with ageing, inflammation, worse immune control of HIV, TDF treatment, and metabolic syndrome.
在人类免疫缺陷病毒（HIV）感染人群中，肾脏疾病（KD）的患病率正在上升。不同因素与之相关，不同发表系列中的情况各异。目的是研究这些患者中KD的患病率、其演变情况以及相关危险因素。对1596例HIV阳性患者进行了一项观察性队列研究，并在2008年和2010年收集了横断面数据。我们获取了临床和实验室指标，并记录了既往或当前使用替诺福韦（TDF）和茚地那韦（IDV）的治疗情况。根据肾病饮食改良（MDRD）方程估算的肾小球滤过率（eGFR）对样本进行分组。第1组：eGFR≤60 mL/（min·1.73 m²）；第2组：eGFR＞60 mL/（min·1.73 m²）。患者中，76.4%为男性，平均年龄（标准差）45±9岁，自诊断HIV以来的时间为14±7年，47.2%的患者既往接受过TDF治疗，39.1%的患者接受过IDV治疗。2008年，eGFR≤低60：4.9%（其中91.4%处于慢性肾脏病[CKD]3期，eGFR为59～30 mL/（min·1.73 m²））；该组患者年龄较大，纤维蛋白原水平较高，更多患者既往接受过TDF和IDV治疗。2010年，eGFR≤60：3.9%（87.1%为3期CKD）。2.4%的队列显示肾功能随时间有所改善，1.3%的队列显示肾功能下降。无高血压以及使用TDF治疗与eGFR改善相关。年龄增加、纤维蛋白原升高、白蛋白降低、糖尿病、高甘油三酯血症以及病毒学控制较差是肾功能损害的危险因素。我们地区的HIV阳性患者CKD患病率为4%至5%（90%为3期CKD），与衰老、炎症、HIV免疫控制较差、TDF治疗以及代谢综合征有关。
