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Prevalence and predictors of renal insufficiency among HIV-infected persons in the study to understand the natural history of HIV/AIDS in the era of effective therapy (SUN)
E.T. Overton1, K. Mondy1, L. Conley2, T. Bush2, F. Rhame3, K. Lichtenstein4, S. Cu-Uvin5, M. Kojic5, K. Wood6, C. Vellozzi2, J.T. Brooks2
1Washington University School of Medicine, St Louis, United States, 2Centers for Disease Control and Prevention, Atlanta, United States, 3Abbott Northwestern Hospital, Minneapolis, United States, 4National Jewish Medical Center, Denver, United States, 5Miriam Hospital, Providence, United States, 6Cerner Corporation, Vienna, United States
Background: Renal disease remains an important complication of HIV infection and may complicate treatment with certain antiretrovirals.
Methods: The SUN Study prospectively follows 682 HIV-infected patients in 4 US cities. Clinical, behavioral, and fasting laboratory data were obtained at baseline. Significant factors identified using univariate analysis were analyzed by multivariate logistic regression to identify independent predictors of glomerular filtration rate (GFR) <90 mL/min/1.73m2. GFR was determined using the simplified modification of diet in renal disease (sMDRD) equation. Odds ratios for GFR <90 mL/min/1.73m2 were based on median values.
Results: Among 635 subjects with available data, the median age was 41 years, 23% were women, 27% were African American, median body mass index (BMI) was 25.5 kg/m2, 79% of subjects were on HAART, median CD4 cell count (CD4) was 457 cell/mL, 59% had HIV RNA (VL) <400 copies/mL, 13% had hypertension (HTN), and 4% had diabetes. Despite low prevalence of chronic renal disease (3% with GFR <60 mL/min/1.73m2), proteinuria (7%), and glucosuria (<1%), 41% had GFR <90. Using multivariate analyses, GFR <90 was associated with greater weight (odds ratio [OR] 1.8 if >67 kg, the 3rd weight quartile, 95% confidence interval [CI] 1.2-2.7); HTN (OR 1.7, CI 1.04-2.8); non-Hispanic white race (OR 1.6, CI 1.1-2.3); current ritonavir use (OR 1.6, CI 1.1-2.4); and current tenofovir use (OR 1.6, CI 1.1-2.4). When excluding the 3% of the cohort with chronic renal disease, the risk estimates remained unchanged.
Conclusions: The prevalence of subclinical renal disease in HIV is high despite potent HAART. Prevalent renal disease was poorly detected by spot urinalysis. Traditional risk factors and certain antiretroviral exposures predicted GFR <90 at baseline. Our data support recommendations to identify early and closely monitor persons with evidence of renal insufficiency to effectively modify risk for progression of renal disease.
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