Role of traditional risk factors and antiretroviral drugs in the incidence of chronic kidney disease, ANRS CO3 Aquitaine cohort, France, 2004-2012

PLoS One. 2013 Jun 12;8(6):e66223. doi: 10.1371/journal.pone.0066223. Print 2013.

Abstract

Objective: To examine the role of antiretroviral drugs (ART), HIV-related and traditional risk factors on the incidence of chronic kidney disease (CKD) in HIV-infected patients.

Design: Prospective hospital-based cohort of HIV-infected patients from 2004 to 2012.

Methods: CKD was defined using MDRD equation as an estimated glomerular filtration rate (eGFR) less than 60 ml/mn/1.73 m(2) at 2 consecutive measurements ≥3 months apart. Poisson regression models were used to study determinants of CKD either measured at baseline or updated. ART exposure was classified as ever or never. We additionally tested the role of tenofovir (TDF), whether or not prescribed concomitantly with a Protease Inhibitor (PI), taking into account the cumulative exposure to the drug.

Results: 4,350 patients (74% men) with baseline eGFR>60 ml/mn/1.73 m(2) were followed for a median of 5.8 years. At the end of follow-up, 96% had received ART, one third of them (35%) jointly received TDF and a PI. Average incidence rate of CKD was 0.95% person-years of follow-up. Incidence of CKD was higher among women (IRR = 2.2), older patients (>60 y vs <45 y: IRR = 2.5 and 45-60 y: IRR = 1.7), those with diabetes (IRR = 1.9), high blood pressure (IRR = 1.5), hyperlipidemia (IRR = 1.5), AIDS stage (IRR = 1.4), low baseline eGFR (IRR = 15.8 for 60<eGFR<70 ml/mn/1.73 m(2) vs >90 and IRR = 7.1 for 70<eGFR<80 ml/mn/1.73 m(2)), current CD4+<200 cells/mm(3) vs >500/mm(3) (IRR = 2.5), and exposure to TDF (IRR = 2.0). Exposure to TDF was even strongly associated with CKD when co-administered with PIs (IRR = 3.1 vs 1.3 when not, p<0,001). A higher risk of CKD was found when tenofovir exposure was >12 months [IRR = 3.0 with joint PIs vs 1.3 without (p<0.001)]. A vast majority of those developing CKD (76.6%) had a baseline eGFR between 60 and 80 ml/mn/1.73 m(2).

Conclusion: In patients with eGFR between 60 and 80 mL/min/1.73 m(2), a thorough control of CKD risk factors is warranted. The use of TDF, especially when co-administered with PIs, should be mentioned as a relative contraindication in presence of at least one of these risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenine / adverse effects
  • Adenine / analogs & derivatives
  • Age Factors
  • Anti-Retroviral Agents / adverse effects*
  • Cohort Studies
  • Contraindications
  • Female
  • France / epidemiology
  • Glomerular Filtration Rate / physiology
  • HIV Infections / complications*
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Organophosphonates / adverse effects
  • Poisson Distribution
  • Prospective Studies
  • Protease Inhibitors / administration & dosage
  • Regression Analysis
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / etiology*
  • Risk Factors
  • Sex Factors
  • Tenofovir

Substances

  • Anti-Retroviral Agents
  • Organophosphonates
  • Protease Inhibitors
  • Tenofovir
  • Adenine

Grants and funding

The ANRS CO3 Aquitaine Cohort is supported by a grant from the Agence Nationale de Recherches sur le SIDA et les Hepatites Virales (ANRS, France) within the Coordinated Action no. 7 (AC7): http://www.anrs.fr/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.