As the HIV population ages, chronic kidney disease (CKD) along with other comorbidities have become highly prevalent among PLWH. Clinical predictors of CKD including diabetes mellitus and hypertension are well-established, however clinical information regarding prognosis after the onset of CKD is limited with most data coming from non-HIV patients. This prospective study from the D:A:D cohort included 595 persons with CKD (eGFR < 60 orwho sustained a 25% decrease in eGFR if they were already < 60 at baseline). The subjects were followed for a median of 3 years until they had a serious clinical event (SCE). These events included end-stage renal disease, liver disease, CVD, AIDS and non-AIDS malignancies, other AIDS-defining condition, or death. During follow-up which ranged from 1 to 5 years, 24% developed at least one SCE with 8% estimated to experience a SCE event by one year following a diagnosis of CKD. The most SCEs were death (13%), non-AIDS malignancy (6%), CVD (6%), other AIDS conditions (5%) and ESRD (3%). Cigarette smoking had the strongest association with all SCEs while diabetes was most predictive of CVD, non-AIDS malignancy, and death. Dyslipidemia was only significantly associated with CVD. Having an eGFR of < 30 was highly predictive of CVD and death.
The D:A:D cohort continues to provide important, long-term observational data for HIV clinicians and researchers. As our patients age with HIV, chronic kidney disease will continue to be an important issue and it carries a large burden of serious clinical events as seen in this study. Regular monitoring of renal function, at least twice a year, is recommended for all persons living with HIV. Dosing adjustment or medication changes may need to be done based on GFR. As with many other co-morbidities, smoking has a significant impact and from this study is the most important modifiable risk factor.
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