HIV linked to increased risk for ESRD in black patients

Issue: November 2007

The risk for end-stage renal disease is six times higher for black patients who have HIV than it is for white patients who have HIV, according to data from a recent study.

To better understand the effect of HIV on progression of renal disease, researchers examined the incidence of ESRD in a national cohort of veterans. They followed a national sample of more than 2 million U.S. veterans for a median of 3.7 years and assessed patients for progression to ESRD.

Of this cohort, 15,135 (0.8%) had HIV, 594,430 (29.5%) had diabetes and 1,408,506 had neither diagnosis. Of those patients diagnosed with HIV, 8,115 (53.6%) were black. In contrast, of those diagnosed with diabetes, only 98,338 (16.5%) were black, and of those with neither diagnosis, 206,636 (14.7%) were black. Compared with patients with neither diagnosis, patients with HIV were younger, and those with diabetes were older.

Prevalence

Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m². At baseline, chronic kidney disease was found in 7.1% of HIV–infected patients, 27.0% of patients with diabetes and 18.4% of patients with neither condition. The prevalence of chronic kidney disease among patients with HIV was similar in white (7.3%) and black (6.9%) patients. However, chronic kidney disease was more common in white patients than black patients among those with diabetes (28.5% vs. 19.5%) as well as those with neither HIV nor diabetes (19.7% vs. 10.5%).

During follow-up, 15,586 cases of ESRD occurred during more than 7 million person-years of observation. Of the patients with HIV, 208 were treated for ESRD during 53,196 person-years of follow-up. Most of these patients were black (n=179, 86.1%). Of the patients with HIV who were treated for ESRD, 27.9% of black patients also had diabetes compared with 55.2% of white patients. Additionally, a total of 9,590 patients with diabetes were treated for ESRD during more than 2 million person-years of follow up, and most of these patients were white (n=6,765, 70.5%).

Causes of ESRD

AIDS nephropathy was the most common cause of ESRD in both black and white patients with HIV. When patients had diagnoses of both HIV and diabetes, diabetes was the most commonly listed cause of ESRD.

After adjusting for other factors, the risk for ESRD for black patients with HIV was six times higher than for white patients with HIV. Additionally, for black patients, HIV was about as strong of a risk factor for ESRD as diabetes.

“Our study demonstrated a striking and unexpected degree of ESRD among HIV–infected people of black race,” Andy I. Choi, MD, of San Francisco General Hospital and the University of California, San Francisco, said in a press release. “On the other hand, among white patients with HIV, rates of ESRD were far lower than among blacks, and HIV did not confer an increased risk for ESRD. We can think of few other risk factors for ESRD that are modified to this extent by race.”

Choi and his colleagues hope that the results from their study will draw attention to the magnitude and extent of kidney disease in the HIV–infected population. “The findings highlight the importance of efforts to improve the management of kidney disease among black patients with HIV infection,” he said. – by Michelle Stephenson

For more information:

Choi A, Rodriguez A, Bacchetti P, et al. Racial differences in end-stage renal disease rates in HIV infection versus diabetes. J Am Soc Nephrol. 2007;18:2968-2974.