The chronic kidney disease in HIV-infected patients

Introduction: frequency of development and risk factors for the formation of kidney pathology in HIV-infected patients need to be clarified. Aim of the study: the purpose of the study was to determine the occurrence of transient signs of kidney pathology, as well as the occurrence and risk factors of chronic kidney disease (CKD) in HIV-infected residents of St. Petersburg when they admitted the Center for AIDS and Other Infectious Diseases. Methods: the study included 840 patients with HIV-infection examined upon registration and after 3-4 months. Results: during the initial screening of patients, glomerular filtration rate (GFR) ≤90 ml/min/1.73 m2 (CKD-EPI 2009) ± the proteinuria more than 1.0 g/l was found in 155 (18.5%) patients. Significant kidney damage in the form of a decrease in GFR to <60 ml/min/1.73 m2 and/or proteinuria in a single urine test of more than 1.0 gram was detected in 44 patients (5.2%). The transitive nature of kidney pathology was recorded in only 17 people out of 155: after 3-4 months, the level of GFR in them was >90 ml/min/1.73 m2 (CKD-EPI 2009). The chronic kidney disease was diagnosed in 162 out of 840 (19.3%) examined patients based on the analysis of anamnestic data, GFR dynamics, urinalysis parameters, and ultrasound examination results. Chronic kidney disease of stages C3-5 was detected in 20 people (2.4%). Logistic regression modeling with reverse conditional inclusion of parameters in the group of patients included in the study (n=840) revealed a significant and independent relationship between the development of CKD stages C3-5 and more advanced stages of HIV-infection, patients’ age, cirrhotic transformation of the liver, when correcting the model for sex, history of drug use, the presence of HCVAb, the level of CD4+ T-lymphocytes <200 cells/μl when registering, and detection of opportunistic infections. Conclusions: basic screening examination (GRF, urine test) reveals high (18.5%) kidney involvement. As many as 19.3% of HIV-infected people suffer from CKD, 2.4% of them had CKD С3-5. The presence of CKD С3-5 associated with more advanced stages of HIV-infection, the patient’, age and the presence of liver cirrhosis.

вирус иммунодефицита человека, ВИЧ, вирус гепатита С, хронический гепатит С, хроническая болезнь почек, human immunodeficiency virus, HIV, hepatitis C virus, HCV, chronic hepatitis C, chronic kidney disease

1. Barre-Sinoussi F., Chermann J.C., Rey F. et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983; 220(4599): 868-871. DOI: 10.1126/science.6189183

2. Gallo R.C., Sarin P.S., Gelmann E.P. et al. Isolation of Human T-cell Leukemia Virus in Acquired Immune Deficiency Syndrome (AIDS). Science. 1983; 220(4599): 865-867. DOI: 10.1126/science.6601823

3. Clavel F., Guetard D., Brun-Vezinet F. et al. Isolation of a new human retrovirus from West African patients with AIDS. Science. 1986; 233(4761): 343-346. DOI: 10.1126/science.2425430

4. Rao T.K., Filippone E.J., Nicastri A.D. et al. Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N Engl J Med. 1984; 310(11): 669-673. DOI: 10.1056/NEJM198403153101101

5. Волгина Г.В., Гаджикулиева М.М. Национальные клинические рекомендации «Хроническая болезнь почек у ВИЧ-инфицированных пациентов (причины, диагностика, принципы ведения)». Нефрология и диализ. 2016; 18(3): 251-272.

6. Brito R.M., Nguyen D.T., Johnson J.R. et al. Chronic kidney disease in patients infected with human immunodeficiency virus (HIV) in an urban cohort. PLoS One. 2019; 14(4): e0215575. DOI: 10.1371/journal.pone.0215575

7. Estrella M.M., Parekh R.S., Astor B.C. et al. Chronic kidney disease and estimates of kidney function in HIV infection: a cross-sectional study in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2011; 57(5): 380-386. DOI: 10.1097/QAI.0b013e318222f461

8. Lopez E.D., Córdova-Cázarez C., Valdez-Ortiz R. et al. Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients. J Bras Nefrol. 2019; 41(1): 48-54. DOI: 10.1590/2175-8239-jbn-2018-0024

9. Kaze F.F., Halle M.P., Mopa H.T. et al. Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study. BMC Nephrol. 2015; 16: 96-103. DOI: 10.1186/s12882-015-0102-9

10. Marie Patrice H., Moussa O., Francois K. et al. Prevalence and associated factors of chronic kidney disease among patients infected with human immunodeficiency virus in Cameroon. Iran J Kidney Dis. 2018; 12(5): 268-274.

11. Abd ElHafeez S., Bolignano D., D'Arrigo G. et al. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open. 2018; 8(1): e015069. DOI: 10.1136/bmjopen-2016-015069

12. Cao Y., Gong M., Han Y. et al. Prevalence and risk factors for chronic kidney disease among HIV-infected antiretroviral therapy-naïve patients in mainland China: a multicenter cross-sectional study. Nephrology (Carlton). 2013; 18(4): 307-312. DOI: 10.1111/nep.12031

13. Hsieh M.H., Lu P.L., Kuo M.C. et al. Prevalence of and associated factors with chronic kidney disease in human immunodeficiency virus-infected patients in Taiwan. J Microbiol Immunol Infect. 2015; 48(3): 256-262. DOI: 10.1016/j.jmii.2013.08.013

14. Yanagisawa N., Muramatsu T., Koibuchi T. et al. Prevalence of chronic kidney disease and poor diagnostic accuracy of dipstick proteinuria in human immunodeficiency virus-infected individuals: a multicenter study in Japan. Open Forum Infect Dis. 2018; 5(10): ofy216. DOI: 10.1093/ofid/ofy216

15. Colson A.W., Florence E., Augustijn H. et al. Prevalence of chronic renal failure stage 3 or more in HIV-infected patients in Antwerp: an observational study. Acta Clin Belg. 2010; 65(6): 392-398. DOI: 10.1179/acb.2010.65.6.004

16. Calza L., Vanino E., Magistrelli E. et al. Prevalence of renal disease within an urban HIV-infected cohort in northern Italy. Clin Exp Nephrol. 2014; 18(1): 104-112. DOI: 10.1007/s10157-013-0817-5

17. Juega-Mariño J., Bonjoch A., Pérez-Alvarez N. et al. Prevalence, evolution, and related risk factors of kidney disease among Spanish HIV-infected individuals. Medicine (Baltimore). 2017; 96(37): e7421. DOI: 10.1097/MD.0000000000007421

18. Levey A.S., Stevens L.A., Schmid C.H. et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9): 604-612. Erratum in: Ann Intern Med. 2011; 155(6): 408. DOI: 10.7326/0003-4819-150-9-200905050-00006

19. Levey A.S., Bosch J.P., Lewis J.B. et al. A more accurate method to estimate glomerular filtration rate from serum creatinine a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann. of Internal Medicine. 1999; 130(6): 471-482. DOI: 10.7326/0003-4819-130-6-199903160-00002

20. Cockcroft D.W., Gault M.H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16 (1): 31-41. DOI: 10.1159/000180580

21. Смирнов А.В., Шилов Е.М., Добронравов В.А. и соавт. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Нефрология. 2012; 16(1): 89-115.

22. Swanepoel C.R., Atta M.G., D'Agati V.D. et al. Conference Participants. Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2018; 93(3): 545-559. DOI: 10.1016/j.kint.2017.11.007

23. Lucas G.M., Ross M.J., Stock P.G. et al. HIV Medicine Association of the Infectious Diseases Society of America. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014; 59(9): e96-138. DOI: 10.1093/cid/ciu617

24. Bland J.M., Altman D.G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 327 (8476): 307-310. DOI: https://doi.org/10.1016/S0140-6736(86)90837-8

25. Ji E., Kim Y.S. Prevalence of chronic kidney disease defined by using CKD-EPI equation and albumin-to-creatinine ratio in the Korean adult population. Korean J Intern Med. 2016; 31(6): 1120-1130. DOI: 10.3904/kjim.2015.193

26. Ekrikpo U.E., Kengne A.P., Bello A.K. et al. Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis. PLoS One. 2018;13(4): e0195443. DOI: 10.1371/journal.pone.0195443

27. Koeda Y., Tanaka F., Segawa T., et al. Comparison between urine albumin-to-creatinine ratio and urine protein dipstick testing for prevalence and ability to predict the risk for chronic kidney disease in the general population (Iwate-KENCO study): a prospective community-based cohort study. BMC Nephrol. 2016; 17(1): 46. DOI: 10.1186/s12882-016-0261-3

28. Гаджикулиева М.М. Хроническая болезнь почек у ВИЧ-инфицированных пациентов: распространеннось и клинико-морфологическая характеристика. Автореф. дисс. на соискание уч. степени д.м.н. 2013. М. 47 с.

29. Mocroft A., Neuhaus J., Peters L. et al. INSIGHT SMART Study Group; ESPRIT Study Group. Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults. PLoS One. 2012; 7(7): e40245. DOI: 10.1371/journal.pone.0040245

30. Peters L., Grint D., Lundgren J.D. et al. EuroSIDA in EuroCoord. Hepatitis C virus viremia increases the incidence of chronic kidney disease in HIV-infected patients. AIDS. 2012; 26(15): 1917-1926. DOI: 10.1097/QAD.0b013e3283574e71

31. Bickel M., Marben W., Betz C. et al. End-stage renal disease and dialysis in HIV-positive patients: observations from a long-term cohort study with a follow-up of 22 years. HIV Med. 2013; 14(3): 127-135. DOI: 10.1111/j.1468-1293.2012.01045.x

32. Fabrizi F., Dixit V., Martin P. Messa P. Hepatitis C virus increases the risk of kidney disease among HIV-positive patients: Systematic review and meta-analysis. J Med Virol. 2016; 88(3): 487-97. DOI: 10.1002/jmv.24353

33. Дунаева Н.В., Гезей М.А., Мазинг А.В. и соавт. Смешанная криоглобулинемия у пациентов с ВИЧ или ВИЧ/ВГС и признаками хронической болезни почек. Нефрология и диализ. 2019; 21(1): 49-57. DOI: 10.28996/2618-9801-2019-1-49-57