The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study

Lene Ryom; Jens D Lundgren; Peter Reiss; Mike Ross; Ole Kirk; Christophe A Fux; Phillipe Morlat; Eric Fontas; Colette Smith; Stephane De Wit; Antonella d'Arminio Monforte; Wafaa El Sadr; Camilla Hatleberg; Andrew Phillips; Caroline Sabin; Matthew Law; Amanda Mocroft

doi:10.1093/infdis/jiaa396

The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study

J Infect Dis. 2021 Feb 24;223(4):632-637. doi: 10.1093/infdis/jiaa396.

Authors

Lene Ryom¹, Jens D Lundgren¹, Peter Reiss^{2

3}, Mike Ross⁴, Ole Kirk¹, Christophe A Fux⁵, Phillipe Morlat⁶, Eric Fontas⁷, Colette Smith⁸, Stephane De Wit⁹, Antonella d'Arminio Monforte¹⁰, Wafaa El Sadr¹¹, Camilla Hatleberg¹, Andrew Phillips⁸, Caroline Sabin⁸, Matthew Law¹², Amanda Mocroft⁸

Affiliations

¹ Rigshospitalet, University of Copenhagen, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen, Denmark.
² Amsterdam University Medical Centers (location AMC), Department of Global Health and Division of Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands.
³ HIV Monitoring Foundation, Amsterdam, The Netherlands.
⁴ Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
⁵ Clinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland.
⁶ Université de Bordeaux, Inserm U 897, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
⁷ Department of Public Health, Nice University Hospital, Nice, France.
⁸ Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom.
⁹ Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
¹⁰ Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy.
¹¹ ICAP-Columbia University and Harlem Hospital, New York, New York, USA.
¹² Kirby Institute, University of New South Wales, Sydney, Australia.

Abstract

Background: Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown.

Methods: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m2.

Results: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24-.80]) vs 0.80 [95% CI, .70-.93]).

Conclusions: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.

Keywords: CD4; CKD; HIV; chronic kidney disease; eGFR; immunosuppression; renal.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
CD4 Lymphocyte Count
Female
Glomerular Filtration Rate
HIV Infections / complications*
HIV Infections / immunology*
Humans
Immune Tolerance*
Incidence
Male
Middle Aged
Prospective Studies
Renal Insufficiency, Chronic / epidemiology*
Renal Insufficiency, Chronic / etiology
Renal Insufficiency, Chronic / immunology
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding