End-stage renal disease and chronic kidney disease in a cohort of African-American HIV-infected and at-risk HIV-seronegative participants followed between 1988 and 2004

AIDS. 2007 Nov 30;21(18):2435-43. doi: 10.1097/QAD.0b013e32827038ad.

Abstract

Background: HIV-infected African-Americans are at increased risk of end-stage renal disease requiring renal replacement therapy (RRT).

Objectives: To compare the incidence of RRT in HIV-infected and HIV-seronegative African-Americans and describe temporal trends in RRT and chronic kidney disease (CKD) in HIV infection.

Design: Cohort study in Baltimore including 4509 HIV-infected and 1746 HIV-seronegative African-Americans.

Methods: Incident RRT was defined by matching participant identifiers with the US Renal Data System; CKD was defined as an estimated glomerular filtration rate < 60 ml/min per 1.73m for >/= 3 months. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated by indirect adjustment. Risk factors for RRT were assessed by person-time methods and Poisson regression.

Results: RRT was initiated in 24 HIV-seronegative subjects over 13 415 person-years of follow-up (SIR, 2.3; 95% CI, 1.5-3.4), in 51 HIV-infected participants without AIDS over 10 780 person-years (SIR, 6.9; 95% CI, 5.1-9.0), and in 125 participants with AIDS over 9833 person-years. SIR, 16.1; 95% CI, 13.4-19.2). In HIV-infected African-Americans, RRT incidences were 5.8 and 9.7/1000 person-years in the pre-HAART and HAART eras, respectively (adjusted rate ratio 1.2; 95% CI, 0.8-1.9). In supplementary analyses, CKD incidence declined significantly in the HAART era compared with pre-HAART, but the CKD period prevalence increased.

Conclusions: Nearly 1% of HIV-infected African-Americans initiated RRT annually, a rate that was similar in the HAART and pre-HAART eras. While new cases of CKD decreased, the prevalence of CKD increased in the HAART era, primarily because survival in those with HIV-associated CKD has improved.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Associated Nephropathy / ethnology*
  • AIDS-Associated Nephropathy / therapy
  • Adult
  • African Americans / statistics & numerical data*
  • Antiretroviral Therapy, Highly Active
  • Baltimore / epidemiology
  • Epidemiologic Methods
  • Female
  • HIV Seronegativity
  • Humans
  • Kidney Failure, Chronic / ethnology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Renal Replacement Therapy / statistics & numerical data
  • Renal Replacement Therapy / trends
  • Socioeconomic Factors