Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, via G. Massarenti 11, 40138, Bologna, Italy.
Unit of Nephrology, Department of Medical and Surgical Sciences, S.Orsola Hospital, University of Bologna, Bologna, Italy.
Clin Exp Nephrol. 2019 Nov;23(11):1272-1279. doi: 10.1007/s10157-019-01768-9. Epub 2019 Jul 20.
Chronic kidney disease (CKD) has become one of the most frequent non-infectious comorbidities in the aging HIV-infected population on long-standing combination antiretroviral therapy (cART).
We conducted a retrospective, cross-sectional study including HIV-infected adult patients attending our HIV outpatient clinic during the years 2017 and 2018 to assess prevalence and associated risk factors of CKD. Estimated glomerular filtration rate (eGFR) was measured by Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. CKD was diagnosed and classified according to the National Kidney Foundation guidelines. Logistic regression was employed to identify factors associated with CKD.
We enrolled 2339 HIV-infected patients (91% were Caucasian) with a mean age of 45.3 years and a mean current CD4 lymphocyte count of 531 cells/mm. CKD was diagnosed in 311 subjects (13.3%). Overall, 294 (12.6%) patients had albuminuria, 108 (4.6%) had eGFR < 60 mL/min/1.73 m, and 78 (3.3%) had albuminuria plus eGFR < 60 mL/min/1.73 m. Stages 4-5 of CKD were documented in 23 (1%) cases. Age greater than 50 years, male gender, hypertension, diabetes mellitus, high triglycerides, nadir CD4 cell count < 200 cells/mm, current use of tenofovir disoproxyl fumarate (TDF) and of TDF plus a ritonavir-boosted protease inhibitors were independently associated with CKD, while current use of abacavir plus one integrase inhibitor was associated with a reduced risk of CKD.
There is a significant prevalence of CKD among HIV-infected persons in association with both traditional and HIV-specific risk factors, requiring a careful periodic monitoring of renal function in these patients.
慢性肾脏病（CKD）已成为长期接受联合抗逆转录病毒治疗（cART）的老年 HIV 感染者中最常见的非传染性合并症之一。
我们进行了一项回顾性、横断面研究，纳入 2017 年和 2018 年在我们的 HIV 门诊就诊的成年 HIV 感染者，以评估 CKD 的患病率和相关危险因素。通过慢性肾脏病流行病学合作（CKD-EPI）方程测量估算肾小球滤过率（eGFR）。根据国家肾脏基金会的指南诊断和分类 CKD。采用逻辑回归分析确定与 CKD 相关的因素。
我们纳入了 2339 名 HIV 感染者（91%为白种人），平均年龄为 45.3 岁，当前 CD4 淋巴细胞计数平均为 531 个/毫米。311 例（13.3%）诊断为 CKD。总体而言，294 例（12.6%）患者有白蛋白尿，108 例（4.6%）eGFR<60 毫升/分钟/1.73 米，78 例（3.3%）有白蛋白尿和 eGFR<60 毫升/分钟/1.73 米。23 例（1%）记录到 CKD 第 4-5 期。年龄大于 50 岁、男性、高血压、糖尿病、高甘油三酯、最低 CD4 细胞计数<200 个/毫米、当前使用替诺福韦二吡呋酯（TDF）和 TDF 加利托那韦增效蛋白酶抑制剂与 CKD 独立相关，而当前使用阿巴卡韦加一种整合酶抑制剂与 CKD 风险降低相关。
HIV 感染者中 CKD 的患病率较高，与传统和 HIV 特异性危险因素相关，需要对这些患者进行定期肾功能监测。
