AKI incidence between 2005, 2015 in patients with HIV on antiretroviral therapy fluctuated
Among patients with HIV on antiretroviral therapy, AKI incidence fluctuated between 2005 and 2015 without significant temporal trends, according to a speaker at ASN Kidney Week.
“Non-infectious comorbidities have tempered the improved longevity among people with HIV on antiretroviral therapy. The few studies have described the epidemiology of AKI among people with HIV in the current era of universal antiretroviral therapy,” Anthony N. Muiru, MD, MPH, of the University of California, San Francisco, said. “Our research objectives are: 1) to quantify the longitudinal trends in AKI over a decade from 2005 to 2015; and 2) evaluate risk factors for AKI among people with HIV on antiretroviral therapy during this time period.”
In a prospective study, Muiru and colleagues measured the incidence and risk factors for hospitalized AKI among patients with HIV (n=1,433; 75% were Black; 34% were women; mean age was 43 years; mean eGFR 106 mL/min/1.73 m²) between 2005 and 2015. Risk factors included patient demographics, behavior characteristics, kidney-related factors and HIV-related factors. All patients were enrolled in the Johns Hopkins HIV Clinical Cohort.
The primary outcome of the study was time to first hospitalized AKI, which was defined as at least 0.3 mg/dL increase in serum creatinine within any 48-hour timeframe or 50% increase in serum creatinine from baseline. AKI occurrence rates were measured using person-years at risk and the associated 95% confidence interval modelled by Poisson distribution. Researchers used multivariable Cox regression models to determine the correlation between risk factors and incident AKI.
While AKI incidence fluctuated between 2005 and 2015, the incidence peaked at 40 per 1,000 person-years in 2007, and the lowest point was 20 per 1,000 person-years in 2010. Multivariable adjustments revealed characteristics independently correlated with AKI included Black race, hypertension, dipstick proteinuria, history of AIDS, CD4 count of less than 200 cells/mm³ and lower serum albumin.
Further, Muiru said, “With universal roll out of antiretroviral therapy among all people with HIV, it is important to treat proteinuria and hypertension and eliminate barriers to equitable care that Black people with HIV face.”
The limitations of this study include it being a single-center study and researchers noted they only captured hospitalized AKI events at Johns Hopkins.
Collapse
Muiru AN, et al. Paper TH-OR03. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).