Incidence and Risk Factors for Acute Kidney Injury in HIV Infection

Li Y et al. – 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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