Incidence and Risk Factors for Acute Kidney Injury in HIV Infection

American Journal of Nephrology, 03/29/2012

Although Acute Kidney Injury incidence has decreased during the highly active antiretroviral therapy era, it remains common in HIV–infected persons and appears attributable to both kidney– and HIV–related factors.

Methods

  • The authors conducted a prospective cohort study of 56,823 HIV-infected persons in the Department of Veterans Affairs Clinical Case Registry.
  • Outcomes were: AKI (acute in-hospital serum creatinine increase of ≥0.3 mg/dl, or a relative increase by 50% or greater), and dialysis-requiring AKI.
  • The authors used proportional hazards regressions to identify risk factors.

Results

  • From its peak in 1995 at 62 per 1,000 person-years, the incidence of AKI declined after the introduction of highly active antiretroviral therapy (HAART) in 1996 to a low point of 25 per 1,000 person-years in 2006.
  • Incidence of dialysis-requiring AKI declined in the early 1990s, but doubled between 2000 and 2006.
  • Using multivariate proportional hazard regression, the authors identified the following strong risk factors for AKI: chronic kidney disease (eGFR <60 ml/min/1.73 m2) (5.38, 95% CI: 5.11-5.67), proteinuria (1.78, 1.70-1.87), low serum albumin (<3.7 mg/dl) (5.24, 4.82-5.71), low body mass index (<18.5 kg/m2) (1.69, 1.54-1.86), cardiovascular disease (1.77, 1.66-1.89), low CD4 count (<200 cells/mm3) (2.54, 2.33-2.77), and high viral load (≥100,000 copies/ml) (2.51, 2.28-2.75).
  • In addition, there was substantial heterogeneity in the strengths of risk factors for dialysis-requiring AKI before and after the introduction of HAART.

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