HIV is a risk factor for acute kidney injury

Individuals with human immunodeficiency virus (HIV) are at increased risk for acute kidney injury (AKI) and later chronic kidney disease (CKD) compared with those without HIV, despite viral suppression, a new study finds.

Among 173,884 patients hospitalized at Montefiore Health System in Bronx, New York, from 2010 to 2019, 4718 patients had HIV, including 2532 (53.7%) who were virally suppressed on antiretroviral therapy (ART), and 2186 (46.3%) who were not virally suppressed.

The risk for in-hospital AKI was significantly increased 1.3- and 1.7-fold for patients with HIV who did and did not have viral suppression, respectively, compared with patients without HIV, in adjusted analyses, Molly C. Fisher, DO, of Montefiore’s Albert Einstein College of Medicine, and colleagues reported in Kidney International. The risk for KDIGO stage 2 or 3 AKI was significantly increased 1.3- and 2.0-fold for the HIV group with and without viral suppression, respectively.

The risk of developing CKD after AKI was a significant 1.4- and 1.5-fold higher for patients with HIV with and without viral suppression, respectively, the investigators reported.

The risk for HIV-associated AKI was elevated 1.8-fold regardless of patient age younger than 40, 41-59, or 60 years or older, Dr Fisher and colleagues noted. Among the subset with AKI requiring kidney replacement therapy, for example, patients with vs without HIV were significantly younger (54 vs 65 years). “These findings suggest that HIV is a more potent risk factor for severe AKI than many traditional risk factors,” according to Dr Fisher’s team. They also observed that ART-treated patients with HIV tend to develop non-AIDS-related comorbidities, including CKD, from 10 to 20 years earlier than people without HIV.

With respect to CKD risk after HIV-associated AKI, the investigators emphasized the need for diligent monitoring of kidney function after hospital discharge, especially because “transition to CKD may have important implications for ART selection and dose adjustment.”

How HIV might increase AKI risk remains unclear. “We speculate that long-term expression of HIV genes in kidney tubular epithelial cells promotes inflammation and kidney aging, which may partially explain increased risk of AKI and progression to CKD among [people with HIV],” Dr Fisher’s team wrote. “Future studies are needed to determine the mechanisms by which HIV promotes AKI and progression to CKD.”

HIV-related factors associated with AKI in this study included a current CD4 cell count of less than 200 cells/mm³, shorter duration of HIV infection, unsuppressed HIV RNA viral load, and lower admission albumin levels. AKI also was more likely to occur in older adults, men, and those with diabetes, hypertension, cardiovascular disease, hepatitis C, or CKD.

By Natasha Persaud

Reference

Fisher MC, Fazzari MJ, Felsen UR, et al. Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy. Kidney Int. Published online August 19, 2023. doi:10.1016/j.kint.2023.07.022