School of Medicine, University of Toronto, Toronto, Canada.
Royal College of Surgeons in Ireland, Dublin, Ireland.
Ir J Med Sci. 2020 Feb;189(1):337-339. doi: 10.1007/s11845-019-02063-y. Epub 2019 Jul 23.
Adults ageing with HIV and on antiretroviral therapy have a greater burden of chronic diseases compared with adults without HIV as reported by Althoff et al. (Curr Opin HIV AIDS 11:527-36, 2016). Therefore, it is important in this clinically stable HIV+ population to monitor and evaluate their risk of chronic kidney disease and intervene when appropriate. The European AIDS Clinical Society (EACS) advise that yearly screening for CKD with eGFR calculation and spot urine protein measurements should be performed (European AIDS Clinical Society Guidelines 2018). The Centre for Excellence for Health, Immunity and Infection (CHIP) have created a validated study calculator to estimate a patient's risk for CKD as reported by Mocroft et al. (PLoS Med 12(3):e1001809, 2015).
(1) To determine the proportion of patients who had a urinary protein-creatinine ratio checked in 2018; (2) To calculate an eGFR for each patient in our cohort utilizing the Modification of Diet in Renal Disease (MDRD) calculation; (3) To calculate the full chronic kidney disease score in our cohort of patients.
We undertook a retrospective chart review of 80 HIV-positive patients who attended our weekly clinic in Beaumont Hospital, Dublin, Ireland.
In our subset of 31 patients who had all the requirements to estimate their eGFR and full chronic kidney disease risk score, 100% (31/31) of eGFRs calculated were reported as > 90 mL/min/1.73 m. The median eGFR was 215 mL/min/1.73 m (range 95.69-418.08 mL/min/1.73 m). The average CHIP full chronic kidney disease 5-year risk score for patients developing CKD was 0.91% (95% CI 0.60-1.21%). One patient was identified with a risk score of 5.05% as they had suffered an acute coronary syndrome event in the past.
Although this audit was small and with limitations, it highlights the importance of collecting relevant and accurate patient data annually to estimate and mitigate the risk of chronic kidney disease in patients with HIV.
正如 Althoff 等人所报道的，与未感染 HIV 的成年人相比，感染 HIV 并接受抗逆转录病毒治疗的成年人患有更多的慢性疾病。（Curr Opin HIV AIDS 11:527-36, 2016）。因此，在这个临床稳定的 HIV+人群中，监测和评估他们患慢性肾脏病的风险，并在适当的时候进行干预是很重要的。欧洲艾滋病临床学会（EACS）建议每年进行一次 CKD 筛查，包括 eGFR 计算和随机尿蛋白测量（欧洲艾滋病临床学会指南 2018）。健康、免疫和感染卓越中心（CHIP）已经创建了一个经过验证的研究计算器，可以根据 Mocroft 等人的报告来估计患者患 CKD 的风险（PLoS Med 12(3):e1001809, 2015）。
（1）确定 2018 年接受尿蛋白/肌酐比值检查的患者比例；（2）利用肾脏病膳食改良试验（MDRD）计算法为我们队列中的每位患者计算 eGFR；（3）计算我们队列中患者的完整慢性肾脏病评分。
我们对在爱尔兰都柏林 Beaumont 医院每周诊所就诊的 80 名 HIV 阳性患者进行了回顾性图表审查。
在我们的 31 名患者亚组中，所有这些要求都可以用来估计他们的 eGFR 和完整的慢性肾脏病风险评分，100%（31/31）的 eGFR 报告值>90 mL/min/1.73 m。中位 eGFR 为 215 mL/min/1.73 m（范围 95.69-418.08 mL/min/1.73 m）。患者发生 CKD 的平均 CHIP 完整慢性肾脏病 5 年风险评分为 0.91%（95%CI 0.60-1.21%）。有一名患者的风险评分为 5.05%，因为他们过去曾发生过急性冠状动脉综合征事件。
尽管这项审计规模较小且存在局限性，但它强调了每年收集相关和准确的患者数据以估计和降低 HIV 患者慢性肾脏病风险的重要性。
