Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand.
Department of Preventive and Social Medicine, Chulalongkorn University, Bangkok, Thailand.
AIDS. 2018 Jan 28;32(3):393-398. doi: 10.1097/QAD.0000000000001698.
As data on chronic kidney disease (CKD) incidence among Asian HIV patients has been limited, the present study aimed to estimate the CKD incidence in HIV-infected patients who received standard antiretroviral therapy in Thailand and to compare baseline demographics and clinical characteristics of the patients who developed CKD with those who do not.
A multicenter, observational prospective cohort of HIV patients with normal kidney functions who received standard antiretroviral therapy.
CKD was diagnosed based on the KDIGO 2012 criteria, using Chronic Kidney Disease Epidemiology Collaboration based estimated glomerular filtration rate with and without urine protein. The cumulative probability of CKD incidence was analyzed using Kaplan-Meier estimation.
Of 5552 patients, 96 patients with pre-existing CKD and 26 patients with incomplete data were excluded, and 5430 patients were analyzed. Their mean age was 39.87 years, 41.52% were women, and 49.45% were homosexual. They were followed up for 49.41 months on average, with 229 incident cases (4.22%) being identified during 22 035 person-years at risk. Overall CKD incidence rate was 10.39 per 1000 person-years. Average time to CKD was 26.4 months (95% confidence interval: 24.44-28.83). The adjusted relative hazard significantly increased by 8.6% and 10.3% for each additional year of patient age and each additional log10 copies/ml of HIV viral load, respectively. Patients with diabetes mellitus and hypercholesterolemia had significantly higher adjusted relative hazard (3.37 and 1.41; P < 0.001 and P = 0.014), respectively.
CKD incidence among the Thai HIV-infected patients was lower than in white and non-Southeast Asian populations. Diabetes, hypercholesterolemia, age, and HIV viral load were the significant risk factors.
ClinicalTrials.gov identifier: NCT01328275.
由于亚洲 HIV 患者慢性肾脏病（CKD）发病率的数据有限，本研究旨在评估在泰国接受标准抗逆转录病毒治疗的 HIV 感染患者的 CKD 发病率，并比较发生 CKD 的患者与未发生 CKD 的患者的基线人口统计学和临床特征。
一项多中心、观察性、前瞻性 HIV 患者队列研究，这些患者的肾功能正常，接受标准抗逆转录病毒治疗。
根据 KDIGO 2012 标准诊断 CKD，使用慢性肾脏病流行病学合作组（Chronic Kidney Disease Epidemiology Collaboration，CKD-EPI）基于估算肾小球滤过率（eGFR）的公式，并结合尿蛋白进行计算。使用 Kaplan-Meier 估计法分析 CKD 发病率的累积概率。
在 5552 名患者中，排除了 96 名患有预先存在的 CKD 患者和 26 名数据不完整的患者，最终对 5430 名患者进行了分析。他们的平均年龄为 39.87 岁，41.52%为女性，49.45%为同性恋。他们的平均随访时间为 49.41 个月，在 22941.83 人年的风险中，共发现 229 例（4.22%）新发 CKD 病例。总体 CKD 发病率为 10.39/1000 人年。CKD 的平均发病时间为 26.4 个月（95%置信区间：24.44-28.83）。患者年龄每增加 1 岁和 HIV 病毒载量每增加 1log10 拷贝/ml，调整后的相对危险度分别显著增加 8.6%和 10.3%。患有糖尿病和高胆固醇血症的患者调整后的相对危险度显著更高（分别为 3.37 和 1.41；P<0.001 和 P=0.014）。
泰国 HIV 感染患者的 CKD 发病率低于白人及非东南亚人群。糖尿病、高胆固醇血症、年龄和 HIV 病毒载量是显著的危险因素。
ClinicalTrials.gov 标识符：NCT01328275。
