Baseline Kidney Function as Predictor of Mortality and Kidney Disease Progression in HIV-Positive Patients

作者：Ibrahim Fowzia; Hamzah Lisa; Jones Rachael; Nitsch Dorothea; Sabin Caroline; Post Frank A^*

来源：American Journal of Kidney Diseases, 2012, 60(4): 539-547.

DOI：10.1053/j.ajkd.2012.03.006

• Estimated glomerular filtration rate (eGFR)
• Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)
• human immunodeficiency virus (HIV)
• chronic kidney disease
• mortality
• competing risk

Background: Chronic kidney disease (CKD) is associated with increased all-cause mortality and kidney disease progression. Decreased kidney function at baseline may identify human immunodeficiency virus (HIV)-positive patients at increased risk of death and kidney disease progression. %26lt;br%26gt;Study Design: Observational cohort study. %26lt;br%26gt;Setting %26 Participants: 7 large HIV cohorts in the United Kingdom with kidney function data available for 20,132 patients. %26lt;br%26gt;Predictor: Baseline estimated glomerular filtration rate (eGFR). %26lt;br%26gt;Outcomes: Death and progression to stages 4-5 CKD (eGFR %26lt;30 mL/min/1.73 m(2) for %26gt;3 months) in Cox proportional hazards and competing-risk regression models. %26lt;br%26gt;Results: Median age at baseline was 34 (25th-75th percentile, 30-40) years, median CD4 cell count was 350 (25th-75th percentile, 208-520) cells/mu L, and median eGFR was 100 (25th-75th percentile, 87-112) mL/min/1.73 m(2). Patients were followed up for a median of 5.3 (25th-75th percentile, 2.0-8.9) years, during which 1,820 died and 56 progressed to stages 4-5 CKD. A U-shaped relationship between baseline eGFR and mortality was observed. After adjustment for potential confounders, eGFRs %26lt;45 and %26gt;105 mL/min/1.73 m(2) remained associated significantly with increased risk of death. Baseline eGFR %26lt;90 mL/min/1.73 m(2) was associated with increased risk of kidney disease progression, with the highest incidence rates of stages 4-5 CKD (%26gt;3 events/100 person-years) observed in black patients with eGFR of 30-59 mL/min/1.73 m(2) and those of white/other ethnicity with eGFR of 30-44 mL/min/1.73 m(2). %26lt;br%26gt;Limitations: The relatively small numbers of patients with decreased eGFR at baseline and low rates of progression to stages 4-5 CKD and lack of data for diabetes, hypertension, and proteinuria. %26lt;br%26gt;Conclusions: Although stages 4-5 CKD were uncommon in this cohort, baseline eGFR allowed the identification of patients at increased risk of death and at greatest risk of kidney disease progression. Am J Kidney Dis. 60(4):539-547.

• 出版日期2012-10