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Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients.
AIDS. 2010 Jul 17; 24(11):1667-78.AIDS

Abstract

OBJECTIVES

Chronic kidney disease (CKD) in HIV-positive persons might be caused by both HIV and traditional or non-HIV-related factors. Our objective was to investigate long-term exposure to specific antiretroviral drugs and CKD.

DESIGN

A cohort study including 6843 HIV-positive persons with at least three serum creatinine measurements and corresponding body weight measurements from 2004 onwards.

METHODS

CKD was defined as either confirmed (two measurements >or=3 months apart) estimated glomerular filtration rate (eGFR) of 60 ml/min per 1.73 m or below for persons with baseline eGFR of above 60 ml/min per 1.73 m or confirmed 25% decline in eGFR for persons with baseline eGFR of 60 ml/min per 1.73 m or less, using the Cockcroft-Gault formula. Poisson regression was used to determine factors associated with CKD.

RESULTS

Two hundred and twenty-five (3.3%) persons progressed to CKD during 21 482 person-years follow-up, an incidence of 1.05 per 100 person-years follow-up [95% confidence interval (CI) 0.91-1.18]; median follow-up was 3.7 years (interquartile range 2.8-5.7). After adjustment for traditional factors associated with CKD and other confounding variables, increasing cumulative exposure to tenofovir [incidence rate ratio (IRR) per year 1.16, 95% CI 1.06-1.25, P < 0.0001), indinavir (IRR 1.12, 95% CI 1.06-1.18, P < 0.0001), atazanavir (IRR 1.21, 95% CI 1.09-1.34, P = 0.0003) and lopinavir/r (IRR 1.08, 95% CI 1.01-1.16, P = 0.030) were associated with a significantly increased rate of CKD. Consistent results were observed in wide-ranging sensitivity analyses, although of marginal statistical significance for lopinavir/r. No other antiretroviral drugs were associated with increased incidence of CKD.

CONCLUSION

In this nonrandomized large cohort, increasing exposure to tenofovir was associated with a higher incidence of CKD, as was true for indinavir and atazanavir, whereas the results for lopinavir/r were less clear.

Authors+Show Affiliations

HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK. a.mocroft@ucl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20523203

Citation

Mocroft, Amanda, et al. "Estimated Glomerular Filtration Rate, Chronic Kidney Disease and Antiretroviral Drug Use in HIV-positive Patients." AIDS (London, England), vol. 24, no. 11, 2010, pp. 1667-78.
Mocroft A, Kirk O, Reiss P, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS. 2010;24(11):1667-78.
Mocroft, A., Kirk, O., Reiss, P., De Wit, S., Sedlacek, D., Beniowski, M., Gatell, J., Phillips, A. N., Ledergerber, B., & Lundgren, J. D. (2010). Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS (London, England), 24(11), 1667-78. https://doi.org/10.1097/QAD.0b013e328339fe53
Mocroft A, et al. Estimated Glomerular Filtration Rate, Chronic Kidney Disease and Antiretroviral Drug Use in HIV-positive Patients. AIDS. 2010 Jul 17;24(11):1667-78. PubMed PMID: 20523203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AU - Mocroft,Amanda, AU - Kirk,Ole, AU - Reiss,Peter, AU - De Wit,Stephane, AU - Sedlacek,Dalibor, AU - Beniowski,Marek, AU - Gatell,Jose, AU - Phillips,Andrew N, AU - Ledergerber,Bruno, AU - Lundgren,Jens D, AU - ,, PY - 2010/6/5/entrez PY - 2010/6/5/pubmed PY - 2010/8/20/medline SP - 1667 EP - 78 JF - AIDS (London, England) JO - AIDS VL - 24 IS - 11 N2 - OBJECTIVES: Chronic kidney disease (CKD) in HIV-positive persons might be caused by both HIV and traditional or non-HIV-related factors. Our objective was to investigate long-term exposure to specific antiretroviral drugs and CKD. DESIGN: A cohort study including 6843 HIV-positive persons with at least three serum creatinine measurements and corresponding body weight measurements from 2004 onwards. METHODS: CKD was defined as either confirmed (two measurements >or=3 months apart) estimated glomerular filtration rate (eGFR) of 60 ml/min per 1.73 m or below for persons with baseline eGFR of above 60 ml/min per 1.73 m or confirmed 25% decline in eGFR for persons with baseline eGFR of 60 ml/min per 1.73 m or less, using the Cockcroft-Gault formula. Poisson regression was used to determine factors associated with CKD. RESULTS: Two hundred and twenty-five (3.3%) persons progressed to CKD during 21 482 person-years follow-up, an incidence of 1.05 per 100 person-years follow-up [95% confidence interval (CI) 0.91-1.18]; median follow-up was 3.7 years (interquartile range 2.8-5.7). After adjustment for traditional factors associated with CKD and other confounding variables, increasing cumulative exposure to tenofovir [incidence rate ratio (IRR) per year 1.16, 95% CI 1.06-1.25, P < 0.0001), indinavir (IRR 1.12, 95% CI 1.06-1.18, P < 0.0001), atazanavir (IRR 1.21, 95% CI 1.09-1.34, P = 0.0003) and lopinavir/r (IRR 1.08, 95% CI 1.01-1.16, P = 0.030) were associated with a significantly increased rate of CKD. Consistent results were observed in wide-ranging sensitivity analyses, although of marginal statistical significance for lopinavir/r. No other antiretroviral drugs were associated with increased incidence of CKD. CONCLUSION: In this nonrandomized large cohort, increasing exposure to tenofovir was associated with a higher incidence of CKD, as was true for indinavir and atazanavir, whereas the results for lopinavir/r were less clear. SN - 1473-5571 UR - https://www.unboundmedicine.com/medline/citation/20523203/Estimated_glomerular_filtration_rate_chronic_kidney_disease_and_antiretroviral_drug_use_in_HIV_positive_patients_ L2 - https://doi.org/10.1097/QAD.0b013e328339fe53 DB - PRIME DP - Unbound Medicine ER -