Risk factors of chronic kidney disease in HIV-infected patients

Clin J Am Soc Nephrol. 2011 Jul;6(7):1700-7. doi: 10.2215/CJN.09191010. Epub 2011 May 12.


Background and objectives: The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients.

Design, setting, participants, & measurements: Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR ≤60 ml/min per 1.73 m² over ≥3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD.

Results: From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm³ had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28).

Conclusions: CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / adverse effects
  • Chronic Disease
  • Female
  • France / epidemiology
  • Glomerular Filtration Rate
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / virology
  • HIV-1 / isolation & purification*
  • Humans
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / physiopathology
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors


  • Anti-Retroviral Agents