Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy

Molly C Fisher; Melissa J Fazzari; Uriel R Felsen; David B Hanna; Nataliya Tappan; Christina M Wyatt; Matthew K Abramowitz; Michael J Ross

doi:10.1016/j.kint.2023.07.022

Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy

Kidney Int. 2023 Nov;104(5):1008-1017. doi: 10.1016/j.kint.2023.07.022. Epub 2023 Aug 19.

Authors

Molly C Fisher¹, Melissa J Fazzari², Uriel R Felsen³, David B Hanna², Nataliya Tappan², Christina M Wyatt⁴, Matthew K Abramowitz⁵, Michael J Ross⁶

Affiliations

¹ Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA. Electronic address: mfisher@montefiore.org.
² Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA.
³ Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA.
⁴ Division of Nephrology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA.
⁵ Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA.
⁶ Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA; Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA.

PMID: 37598853
DOI: 10.1016/j.kint.2023.07.022

Abstract

In the modern era, it is unknown if people that are virally suppressed with HIV (PWH) are at increased risk for acute kidney injury (AKI) compared to people without HIV and no studies have compared the risk of AKI by viral suppression status. Here, we determined the associations of HIV status and AKI among PWH with and without viral suppression compared to people without HIV. An observational cohort study of PWH and people without HIV hospitalized in a large New York City health system between 2010-2019 was conducted. Multivariable Cox proportional hazards models were used to determine associations between HIV status and risk of AKI, severe AKI and development of chronic kidney disease (CKD). Among 173,884 hospitalized patients, 4,718 had HIV; 2,532 (53.7%) were virally suppressed and 2,186 (46.3%) were not suppressed. Compared to people without HIV, PWH with and without viral suppression were at increased risk of AKI (adjusted hazard ratio 1.27, 95% confidence interval 1.15, 1.40 and 1.73, 1.58, 1.90, respectively) and AKI requiring kidney replacement therapy (1.89, 1.27, 2.84 and 1.87, 1.23, 2.84, respectively). Incremental, graded associations were observed between HIV status and Stage 2 or 3 AKI, and among AKI survivors, and incident CKD. The elevated risk of AKI across ages of PWH was similar in magnitude to older people without HIV. Thus, regardless of virologic control, HIV is an independent risk factor for AKI among hospitalized patients. Future studies should determine the mechanisms by which HIV increases susceptibility to AKI and identify strategies to prevent AKI in PWH.

Keywords: HIV; acute kidney injury; hospital; outcomes.