Office of Graduate Medical Education, Houston Methodist Research Institute, Houston, Texas, United States of America.
Houston Methodist Research Institute, Houston, Texas, United States of America.
PLoS One. 2019 Apr 17;14(4):e0215575. doi: 10.1371/journal.pone.0215575. eCollection 2019.
HIV-infected patients are at risk for developing chronic kidney disease (CKD), defined by estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2. Our purpose was to understand the genesis of CKD in HIV patients from a large urban clinic in Houston, Texas, USA, and to characterize progression of CKD in the cohort.
DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A retrospective cohort study (2012-2016) was conducted in all HIV-infected patients seen in a federally qualified community health center in Houston, Texas. CKD prevalence and its association with HIV viral load and CD4 count were determined. The association of the change in eGFR over time and comorbidities was assessed using linear mixed models.
Of 3714 HIV-infected patients analyzed, 153 (4.1%) had CKD. The prevalence of CKD in the different racial groups was 5.4% White, 4.0% African American, 2.8% Hispanic/Latino and 3.2% Asian. There was no difference in the rate of decline in kidney function in White vs. African American HIV infected patients with CKD. Compared with non-CKD patients, CKD patients were older, had lived longer with HIV infection, had lower CD4 cell counts, higher proportions of hypertension, hyperlipidemia, and cerebrovascular disease, and had significantly higher rates of eGFR deterioration represented by a median decrease of 26.5% from first to last follow-up eGFR (versus 0% change). Linear mixed modeling identified older age, male gender, White race, longer time with HIV infection, hypertension, history of kidney stones, cerebrovascular disease, autoimmune disease, increased potassium and total cholesterol levels, and being treated with combination ART as associated with a worsening eGFR over time.
This study demonstrates a prevalence of CKD in HIV-infected patients of 4.1% and points to an important role for HIV medications and other common comorbidities in the genesis and progression of kidney disease. Importantly, CKD was not more prevalent in African Americans than in Whites, perhaps due to a low prevalence of IV drug abuse as inferred from the lower prevalence of HCV infection in this cohort.
HIV 感染者存在发生慢性肾脏病（CKD）的风险，其定义为估算肾小球滤过率（eGFR）<60ml/min/1.73m2。本研究旨在了解美国德克萨斯州休斯顿市一家大型城市诊所中 HIV 患者 CKD 的发病机制，并对该队列中 CKD 的进展情况进行特征描述。
设计、地点、参与者和测量：对在德克萨斯州休斯顿市一家经联邦政府认证的社区卫生中心就诊的所有 HIV 感染者进行回顾性队列研究（2012-2016 年）。确定 CKD 的患病率及其与 HIV 病毒载量和 CD4 计数的关系。使用线性混合模型评估 eGFR 随时间变化与合并症的关系。
在分析的 3714 例 HIV 感染者中，有 153 例（4.1%）患有 CKD。不同种族组的 CKD 患病率分别为：白人 5.4%、非裔美国人 4.0%、西班牙裔/拉丁裔 2.8%和亚裔 3.2%。CKD 白人 HIV 感染者与非 CKD 患者肾功能下降率无差异。与非 CKD 患者相比，CKD 患者年龄更大，HIV 感染时间更长，CD4 细胞计数更低，高血压、高血脂和脑血管疾病的比例更高，eGFR 恶化率显著更高，中位 eGFR 从首次随访到最后一次随访下降 26.5%（相比之下为 0%的变化）。线性混合模型确定年龄较大、男性、白人种族、HIV 感染时间较长、高血压、肾结石史、脑血管疾病、自身免疫性疾病、血钾和总胆固醇水平升高以及接受联合 ART 治疗与 eGFR 随时间恶化相关。
本研究表明 HIV 感染者的 CKD 患病率为 4.1%，表明 HIV 药物和其他常见合并症在肾脏疾病的发生和进展中起重要作用。重要的是，非裔美国人 CKD 的患病率并不高于白人，这可能是由于该队列中丙型肝炎病毒感染的患病率较低，表明静脉药物滥用的患病率较低。
