HIV care and the incidence of acute renal failure

Clin Infect Dis. 2008 Jul 15;47(2):242-9. doi: 10.1086/589296.

Abstract

Background: The clinical epidemiology of acute renal failure (ARF) in human immunodeficiency virus (HIV)-infected patients remains poorly defined.

Methods: We conducted a retrospective analysis of patients who developed ARF while attending King's College Hospital (London, United Kingdom) during January 1998-December 2005. Serum creatinine level and estimated glomerular filtration rate were used to identify ARF. ARF episodes were classified as early onset if they occurred <3 months after initiation of HIV care and as late onset if they occurred > or =3 months after initiation of HIV care.

Results: During the study period, 130 (5.7%) of 2274 patients developed 144 episodes of ARF. The incidences of early-onset and late-onset ARF were 19.3 episodes per 100 person-years (95% confidence interval [CI], 15.4-24.1 episodes per 100 person-years) and 1.1 episodes per 100 person-years (95% CI, 0.83-1.49 episodes per 100 person-years), respectively (rate ratio, 17.4; P<0.001). In multivariate analysis, nadir CD4 T cell count <100 x 10(9) cells/L (odds ratio [OR], 6.7; 95% CI, 2.5-18.3) and acquired immunodeficiency syndrome (OR, 6.7; 95% CI, 3.4-13.3) were associated with early-onset ARF, whereas injection drug use (OR, 4.8; 95% CI, 1.3-17.7), hepatitis C virus coinfection (OR, 3.4; 95% CI, 1.3-8.6), and nadir CD4 T cell count <100 x 10(9) cells/L (OR, 5.8; 95% CI, 2.5-13.4) were associated with late-onset ARF.

Conclusions: ARF was common and was associated with advanced immunodeficiency. The incidence of ARF decreased >10-fold in patients who had received HIV care for > or =3 months.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / complications
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology*
  • Adult
  • African Continental Ancestry Group
  • Anti-Retroviral Agents / adverse effects
  • Antiretroviral Therapy, Highly Active / adverse effects
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Hepatitis C / complications
  • Humans
  • Incidence
  • Kidney / blood supply
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Sexual Behavior
  • Statistics, Nonparametric
  • Substance Abuse, Intravenous / complications
  • T-Lymphocytopenia, Idiopathic CD4-Positive / complications

Substances

  • Anti-Retroviral Agents