Muiru Anthony N, Madden Erin, Chilingirian Ani, Rubinsky Anna D, Scherzer Rebecca, Moore Richard, Villalobos Celia P Corona, Monroy Trujillo Jose Manuel, Parikh Chirag R, Hsu Chi-Yuan, Shlipak Michael G, Estrella Michelle M
Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA.
Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA.
HIV Med. 2022 Jul;23(6):611-619. doi: 10.1111/hiv.13216. Epub 2021 Dec 12.
The epidemiology of hospitalized acute kidney injury (AKI) among people living with HIV (PLWH) in the era of modern antiretroviral therapy (ART) for all PLWH is not well characterized. We evaluated the incidence of and risk factors for hospitalized AKI from 2005 to 2015 among PLWH on ART.
We conducted a retrospective analysis of PLWH from the Johns Hopkins HIV Clinical Cohort. We defined hospitalized AKI as a rise of ≥ 0.3 mg/dL in serum creatinine (SCr) within any 48-h period or a 50% increase in SCr from baseline and assessed associations of risk factors with incident AKI using multivariate Cox regression models.
Most participants (75%) were black, 34% were female, and the mean age was 43 years. The incidence of AKI fluctuated annually, peaking at 40 per 1000 person-years (PY) [95% confidence interval (CI) 22-69 per 1000 PY] in 2007, and reached a nadir of 20 per 1000 PY (95% CI 11-34 per 1000 PY) in 2010. There was no significant temporal trend (-3.3% change per year; 95% CI -8.6 to 2.3%; P = 0.24). After multivariable adjustment, characteristics independently associated with AKI included black race [hazard ratio (HR) 2.44; 95% CI 1.42-4.20], hypertension (HR 1.62; 95% CI 1.09-2.38), dipstick proteinuria > 1 (HR 1.86; 95% CI 1.07-3.23), a history of AIDS (HR 1.82; 95% CI 1.29-2.56), CD4 count < 200 cells/µL (HR 1.46; 95% CI 1.02-2.07), and lower serum albumin (HR 1.73 per 1 g/dL decrease; 95% CI 1.02-2.07).
In this contemporary cohort of PLWH, the annual incidence of first AKI fluctuated during the study period. Attention to modifiable AKI risk factors and social determinants of health may further reduce AKI incidence among PLWH.
在所有感染人类免疫缺陷病毒（HIV）者均可接受现代抗逆转录病毒治疗（ART）的时代，HIV感染者（PLWH）中住院急性肾损伤（AKI）的流行病学特征尚不明确。我们评估了2005年至2015年接受ART治疗的PLWH中住院AKI的发病率及危险因素。
我们对约翰霍普金斯HIV临床队列中的PLWH进行了回顾性分析。我们将住院AKI定义为在任何48小时内血清肌酐（SCr）升高≥0.3mg/dL，或SCr较基线水平升高50%，并使用多变量Cox回归模型评估危险因素与新发AKI之间的关联。
大多数参与者（75%）为黑人，34%为女性，平均年龄为43岁。AKI的发病率每年波动，2007年达到峰值，为每1000人年40例[95%置信区间（CI）为每1000人年22 - 69例]，2010年降至最低点，为每1000人年20例（95%CI为每1000人年11 - 34例）。没有显著的时间趋势（每年变化-3.3%；95%CI为-8.6%至2.3%；P = 0.24）。多变量调整后，与AKI独立相关的特征包括黑人种族[风险比（HR）2.44；95%CI为1.42 - 4.20]、高血压（HR 1.62；95%CI为1.09 - 2.38）、试纸法蛋白尿>1（HR 1.86；95%CI为1.07 - 3.23）、艾滋病病史（HR 1.82；95%CI为1.29 - 2.56）、CD4细胞计数<200个/µL（HR 1.46；95%CI为1.02 - 2.07）以及较低的血清白蛋白（每降低1g/dL，HR 1.73；95%CI为1.02 - 2.07）。
在这个当代PLWH队列中，首次AKI的年发病率在研究期间有所波动。关注可改变的AKI危险因素及健康的社会决定因素可能会进一步降低PLWH中AKI的发病率。
