Chronic kidney disease incidence, and progression to end-stage renal disease, in HIV-infected individuals: a tale of two races

J Infect Dis. 2008 Jun 1;197(11):1548-57. doi: 10.1086/587994.

Abstract

Background: Little is known about the racial differences in the incidence and progression of HIV-related chronic kidney disease (CKD) that underlie African American-white disparities in HIV-related end-stage renal disease (ESRD).

Methods: In a cohort in Baltimore, Maryland, we measured CKD incidence, glomerular filtration rate (GFR) slope, and progression to ESRD in 3332 African American and 927 white HIV-infected subjects.

Results: A total of 284 subjects developed CKD, 100 (35%) of whom subsequently developed ESRD. African American subjects were at slightly increased risk for incident CKD, compared with white subjects (hazard ratio [HR], 1.9 [95% confidence interval {CI}, 1.2-2.8]). However, once CKD had commenced, the African American subjects developed ESRD markedly faster than did the white subjects (HR, 17.7 [95% CI, 2.5-127.0]), and, correspondingly, their GFR decline after diagnosis of CKD was 6-fold more rapid (P < .001). In the subset of African American subjects for whom kidney-biopsy data were available, progression to ESRD was significantly faster than that in white subjects with CKD, irrespective of the presence of HIV-associated nephropathy.

Conclusions: The results of this study suggest that African American-white disparities in HIV-related ESRD are explained predominantly by a more aggressive natural disease history in African Americans and less by racial differences in CKD incidence.

Publication types

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

MeSH terms

  • AIDS-Associated Nephropathy / ethnology*
  • Adult
  • African Americans
  • Baltimore / epidemiology
  • European Continental Ancestry Group
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / ethnology*
  • Male
  • Middle Aged
  • Time Factors