Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.
With the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR) and associated risk factors in a coh...
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Public Library of Science (PLoS)
2014-01-01
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| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0093748&type=printable |
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| author | Patrícia Santiago Beatriz Grinsztejn Ruth Khalili Friedman Cynthia B Cunha Lara Esteves Coelho Paula Mendes Luz Albanita Viana de Oliveira Ronaldo Ismério Moreira Sandra W Cardoso Valdilea G Veloso José H Rocco Suassuna |
| author_facet | Patrícia Santiago Beatriz Grinsztejn Ruth Khalili Friedman Cynthia B Cunha Lara Esteves Coelho Paula Mendes Luz Albanita Viana de Oliveira Ronaldo Ismério Moreira Sandra W Cardoso Valdilea G Veloso José H Rocco Suassuna |
| author_sort | Patrícia Santiago |
| collection | DOAJ |
| description | With the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR) and associated risk factors in a cohort of HIV-infected patients from a middle-income country. Our cross-sectional study included all adult patients who attended an urban outpatient clinic in 2008. GFR was estimated using the CKD-EPI equation. The prevalence ratio (PR) of decreased GFR (defined as <60 mL/min/1.73 m(2)) was estimated using generalizing linear models assuming a Poisson distribution. We analyzed data from 1,970 patients, of which 82.9% had been exposed to ART. A total of 249 patients (12.6%) had a GFR between 60 and 89 mL/min/1.73 m(2), 3.1% had a GFR between 30 and 59, 0.3% had a GFR between 15 and 29, and 0.4% had a GFR <15. Decreased GFR was found in only 74 patients (3.8%). In the multivariate regression model, the factors that were independently associated with a GFR below 60 mL/min/1.73 m(2) were as follows: age ≥ 50 years (PR = 3.4; 95% CI: 1.7-6.8), diabetes (PR = 2.0; 95% CI: 1.2-3.4), hypertension (PR = 2.0; 95% CI: 1.3-3.2), current CD4+ cell count <350 cells/mm3 (PR = 2.1; 95% CI: 1.3-3.3), past exposure to tenofovir (PR = 4.7; 95% CI: 2.3-9.4) and past exposure to indinavir (PR =1.7; 95% CI: 1.0-2.8). As in high-income countries, CKD was the predominant form of kidney involvement among HIV-infected individuals in our setting. The risk factors associated with decreased glomerular filtration were broad and included virus-related factors as well as degenerative and nephrotoxic factors. Despite the potential for nephrotoxicity associated with some antiretroviral drugs, in the short-term, advanced chronic renal disease remains very rare. |
| format | Article |
| id | doaj-art-0e1f6ca45296497eadfcfd3a96ab4bc5 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-0e1f6ca45296497eadfcfd3a96ab4bc52025-08-20T03:00:35ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0194e9374810.1371/journal.pone.0093748Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.Patrícia SantiagoBeatriz GrinsztejnRuth Khalili FriedmanCynthia B CunhaLara Esteves CoelhoPaula Mendes LuzAlbanita Viana de OliveiraRonaldo Ismério MoreiraSandra W CardosoValdilea G VelosoJosé H Rocco SuassunaWith the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR) and associated risk factors in a cohort of HIV-infected patients from a middle-income country. Our cross-sectional study included all adult patients who attended an urban outpatient clinic in 2008. GFR was estimated using the CKD-EPI equation. The prevalence ratio (PR) of decreased GFR (defined as <60 mL/min/1.73 m(2)) was estimated using generalizing linear models assuming a Poisson distribution. We analyzed data from 1,970 patients, of which 82.9% had been exposed to ART. A total of 249 patients (12.6%) had a GFR between 60 and 89 mL/min/1.73 m(2), 3.1% had a GFR between 30 and 59, 0.3% had a GFR between 15 and 29, and 0.4% had a GFR <15. Decreased GFR was found in only 74 patients (3.8%). In the multivariate regression model, the factors that were independently associated with a GFR below 60 mL/min/1.73 m(2) were as follows: age ≥ 50 years (PR = 3.4; 95% CI: 1.7-6.8), diabetes (PR = 2.0; 95% CI: 1.2-3.4), hypertension (PR = 2.0; 95% CI: 1.3-3.2), current CD4+ cell count <350 cells/mm3 (PR = 2.1; 95% CI: 1.3-3.3), past exposure to tenofovir (PR = 4.7; 95% CI: 2.3-9.4) and past exposure to indinavir (PR =1.7; 95% CI: 1.0-2.8). As in high-income countries, CKD was the predominant form of kidney involvement among HIV-infected individuals in our setting. The risk factors associated with decreased glomerular filtration were broad and included virus-related factors as well as degenerative and nephrotoxic factors. Despite the potential for nephrotoxicity associated with some antiretroviral drugs, in the short-term, advanced chronic renal disease remains very rare.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0093748&type=printable |
| spellingShingle | Patrícia Santiago Beatriz Grinsztejn Ruth Khalili Friedman Cynthia B Cunha Lara Esteves Coelho Paula Mendes Luz Albanita Viana de Oliveira Ronaldo Ismério Moreira Sandra W Cardoso Valdilea G Veloso José H Rocco Suassuna Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country. PLoS ONE |
| title | Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country. |
| title_full | Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country. |
| title_fullStr | Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country. |
| title_full_unstemmed | Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country. |
| title_short | Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country. |
| title_sort | screening for decreased glomerular filtration rate and associated risk factors in a cohort of hiv infected patients in a middle income country |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0093748&type=printable |
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