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Original ArticlesEpidemiology and Outcomes
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Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Philippe Flandre, Pascal Pugliese, Lise Cuzin, Corinne Isnard Bagnis, Ivan Tack, André Cabié, Isabelle Poizot-Martin, Christine Katlama, Cécile Brunet-François, Yazdan Yazdanpanah and Pierre Dellamonica
CJASN July 2011, 6 (7) 1700-1707; DOI: https://doi.org/10.2215/CJN.09191010
Philippe Flandre
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Pascal Pugliese
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Lise Cuzin
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Corinne Isnard Bagnis
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Ivan Tack
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André Cabié
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Isabelle Poizot-Martin
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Christine Katlama
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Cécile Brunet-François
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Yazdan Yazdanpanah
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Pierre Dellamonica
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    Figure 1.

    The Cox's model with delayed entry (date of first creatinine measurement): the example of seven hypothetical subjects.

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    Table 1.

    Description of the patients without and with CKD

    MDRD
    Patients without CKDPatients with CKDAll Patients
    n = 7029%n = 349%n = 7378%
    Male494870.424169.1518970.3
    ART-naïvea77011.0267.478610.7
    Previous AIDSb160222.810229.2170423.1
    Previous acute kidney injuryb127718.28323.8136018.4
    Hepatitis B coinfection5127.3349.75467.4
    Hepatitis C coinfection150521.47722.1158221.4
    Hypertension101814.516647.6118416.0
    Diabetes2653.8339.52984.0
    Median (IQR)
    Age at HIV diagnosis (years)31 (25.5 to 38.6)c39 (30.1 to 50.1)d31.2 (25.6 to 39.1)
    CD4 nadir368 (238 to 532)e288 (156 to 479)365 (234 to 529)
    Baseline body mass index22.3 (20.3 to 24.5)b22.9 (20.7 to 25.6)e22.3 (20.3 to 24.6)
    Delay from HIV diagnosis to initiation of ART (years)2.3 (0.2 to 6.6)c2 (0.25.7)d2.2 (0.2 to 6.6)
    • MDRD, Modification of Diet in Renal Disease; IQR, interquartile range; CKD, chronic kidney disease; ART, antiretroviral therapy.

    • ↵a At time of CKD or last clinic visit, whichever occurred first.

    • ↵b Information missing in 32 patients.

    • ↵c Information missing in 48 patients.

    • ↵e Information missing in four patients.

    • ↵d Information missing in two patients.

    • e Information missing for one patient.

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    Table 2.

    Number of patients exposed to each drug since their first eGFR

    Calendar yearsAZT3TCABCDDIDDCD4TTDFFTCNVPEFVFAPVSQVIDVNFVLPVATV
    ≤199410100341840000020000
    1995 to 199645529202072681840011093153100
    1997 to 1998621686343492255590015049124637822810
    1999 to 200076210562925221057981340235932218374379742
    2001 to 2002205029361211121811612734742989684415932753246269410
    2003 to 20042731408116761230899001390179111410214393644884091347530
    2005 to 2006276844812128103036435212613661105105787835823324014531314
    Overall4199559827742192461192025081375186517901135845114188320411373
    • 3TC, —; ABC, —; DDI, —; DDC, —; D4T, —; TDF, —; FTC, —; NVP, —; EFV, —; FAPV, —; SQV, —; IDV, indinavir; NFV, —; LPV, —; ATV, eGFR, estimated GFR; AZT, aziothymidine.

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    Table 3.

    Rate of CKD across the different calendar periods

    YearsNumber of patientsPerson-years since First eGFRNumber with CKDRate/1,000 Person-years (95% CI)
    HIV DiagnosisInitiation of ARTFirst GFR Estimation
    ≤199435321062254510.823.9 (0 to 9.3)
    1995 to 19967101260450870.21416.1 (7.7 to 24.5)
    1997 to 199862413123651787.72715.1 (9.4 to 20.8)
    1999 to 20005897935832610.4114.2 (1.7 to 6.7)
    2001 to 200263874527285849.16410.9 (8.3 to 13.6)
    2003 to 200471677161410086.612212.1 (9.9 to 14.2)
    2005 to 2006543643138410605.110910.3 (8.3 to 12.2)
    • CI, confidence interval.

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    Table 4.

    Results of the Cox's model

    VariableUnadjustedAdjusteda
    HR (95% CI)PHR (95% CI)P
    Occurrence of acute kidney injury2.73 (2.09 to 3.58)<0.012.40 (1.80 to 3.20)<0.01
    Time with CD4 >200 cells/mm3a0.48 (0.38 to 0.61)<0.010.63 (0.48 to 0.81)0.03
    Time with VL <500 copies/mla1.02 (0.82 to 1.27)0.850.88 (0.69 to 1.11)0.27
    Occurrence of an AIDS-defining event1.73 (1.369 to 2.19)<0.011.19 (0.93 to 1.54)0.17
    Hepatitis B1.34 (0.94 to 1.91)0.111.13 (0.78 to 1.63)0.53
    Hepatitis C0.90 (0.69 to 1.17)0.421.07 (0.81 to 1.41)0.65
    Hypertension4.36 (3.52 to 5.39)<0.012.39 (1.88 to 3.04)<0.01
    Diabetes2.52 (1.75 to 3.62)<0.011.23 (0.84 to 1.80)0.30
    Past exposure
        AZT1.12 (0.85 to 1.47)0.430.88 (0.62 to 1.26)0.48
        3TC1.67 (1.14 to 2.45)0.090.89 (0.52 to 1.51)0.89
        ABC1.25 (0.88 to 1.77)0.220.92 (0.62 to 1.36)0.67
        DDI1.09 (0.86 to 1.39)0.480.84 (0.63 to 1.23)0.25
        DDC1.01 (0.77 to 1.32)0.950.93 (0.69 to 1.26)0.64
        D4T1.15 (0.90 to 1.48)0.270.93 (0.67 to 1.29)0.67
        TDF2.61 (1.69 to 4.04)<0.012.23 (1.37 to 3.63)0.01
        FTC1.41 (0.20 to 10.13)0.731.03 (0.14 to 7.66)0.98
        SQV0.98 (0.70 to 1.37)0.880.74 (0.51 to 1.08)0.12
        IDV1.38 (1.08 to 1.77)0.011.28 (0.97 to 1.70)0.08
        NFV0.85 (0.63 to 1.15)0.300.78 (0.56 to 1.09)0.15
        LPV1.40 (0.92 to 2.12)0.111.04 (0.66 to 1.64)0.88
        ATV2.06 (0.75 to 5.63)0.161.24 (0.43 to 3.55)0.69
        FAPV1.38 (0.75 to 2.55)0.300.93 (0.47 to 1.84)0.83
        NVP0.83 (0.60 to 1.16)0.270.75 (0.52 to 1.09)0.13
        EFV1.13 (0.83 to 1.53)0.441.00 (0.72 to 1.40)0.99
    Recent exposure
        AZT0.78 (0.59 to 1.04)0.100.62 (0.42 to 0.91)0.02
        3TC1.77(1.27 to 2.45)0.011.24 (0.76 to 2.04)0.39
        ABC1.40 (1.08 to 1.81)0.121.37 (1.03 to 1.82)0.03
        DDI0.77 (0.55 to 1.07)0.120.75 (0.52 to 1.08)0.13
        DDC0.33 (0.12 to 0.91)0.030.40 (0.14 to 1.14)0.09
        D4T1.56 (1.15 to 2.11)0.041.17 (0.81 to 1.70)0.4
        TDF1.67 (1.24 to 2.31)0.011.55 (1.09 to 2.20)0.02
        FTC1.06 (0.56 to 2.00)0.850.94 (0.47 to 1.89)0.87
        SQV1.04 (0.66 to 1.63)0.880.94 (0.59 to 1.51)0.8
        IDV2.32 (1.68 to 3.21)<0.012.03 (1.42 to 2.90)<0.01
        NFV0.94 (0.58 to 1.53)0.800.96 (0.58 to 1.59)0.87
        LPV1.36 (0.99 to 1.85)0.051.30 (0.92 to 1.85)0.14
        ATV1.77 (1.18 to 2.65)0.061.47 (0.94 to 2.30)0.09
        FAPV0.75 (0.42 to 1.35)0.340.72 (0.39 to 1.32)0.29
        NVP0.96 (0.69 to 1.33)0.801.08 (0.76 to 1.54)0.68
        EFV0.97 (0.70 to 1.35)0.851.02 (0.71 to 1.46)0.92
    • ↵a Values after adjustment for age, gender, BMI, time since HIV diagnosis, cumulative exposure to any ART, and number of ART drugs received. 3TC, lamivudine; ABC, abacavir; DDI, didanosine; DDC, zalcitabine; D4T, stavudine; TDF, tenofovir; FTC, emtricitabine; NVP, névirapine; EFV, efavirenz; FAPV, fosAmprenavir; SQV, saquinavir; IDV, indinavir; NFV, nelfinavir; LPV, lopinavit; ATV, atazanavir. Bold values indicated statistically significant difference.

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Clinical Journal of the American Society of Nephrology: 6 (7)
Clinical Journal of the American Society of Nephrology
Vol. 6, Issue 7
1 Jul 2011
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Risk Factors of Chronic Kidney Disease in HIV-infected Patients
Philippe Flandre, Pascal Pugliese, Lise Cuzin, Corinne Isnard Bagnis, Ivan Tack, André Cabié, Isabelle Poizot-Martin, Christine Katlama, Cécile Brunet-François, Yazdan Yazdanpanah, Pierre Dellamonica
CJASN Jul 2011, 6 (7) 1700-1707; DOI: 10.2215/CJN.09191010

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Risk Factors of Chronic Kidney Disease in HIV-infected Patients
Philippe Flandre, Pascal Pugliese, Lise Cuzin, Corinne Isnard Bagnis, Ivan Tack, André Cabié, Isabelle Poizot-Martin, Christine Katlama, Cécile Brunet-François, Yazdan Yazdanpanah, Pierre Dellamonica
CJASN Jul 2011, 6 (7) 1700-1707; DOI: 10.2215/CJN.09191010
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