To prevent kidney disease, control diabetes and HIV — and keep people in care, long-term study indicates

In people living with HIV (PLWH) in South Carolina, the long-term risk of developing chronic kidney disease (CKD) is associated with diabetes, periods of viremia, and the length of time out of care, according to the findings of a long-term cohort study.

About This Study

“The Incidence and Dynamic Risk Factors of Chronic Kidney Disease Among People Living With HIV – A Population-based Cohort Study“ was published online on July 19, 2023, in AIDS. The lead author is Haoyuan Gao, Ph.D., M.P.H., of the South Carolina SmartState Center for Healthcare Quality and the Department of Epidemiology and Biostatistics, both at the Arnold School of Public Health of the University of South Carolina in Columbia.

Key Research Findings

This population-based cohort study of 9,514 PLWH diagnosed between 2006 and 2019 and followed for a median of 6.7 years investigated factors associated with developing CKD. Seventy-seven percent of participants were men, 69% of participants were Black, and the mean age was 35 years. All were CKD-free at baseline. Models assessed CKD incidence and risk over 5, 10, and 15 years.

Overall CKD incidence was 12.39/1000 person-years. Being older or being Black were associated with a higher risk of developing renal disease. As in the general population, CKD was more common in participants with hypertension, dyslipidemia, cardiovascular disease, or diabetes.

Being virally suppressed for >20% of days with HIV, being in care for >30% of days with HIV, and having a recent CD4 count of >200 cells/mm³ were all associated with a lower risk of CKD, as was a baseline CD4 count <200 cells/mm³.

In participants without CKD for >10 years after HIV diagnosis, only diabetes, dyslipidemia, and earlier year of HIV diagnosis remained as risk factors, while longer retention in care and higher recent CD4 cell counts were protective.

Discussion Highlights and Implications for Practice

The reported study limitations included reliance on health record codes and the lack of information on specific antiretroviral medications or lifestyle factors, such as alcohol consumption. Findings may also not be generalizable beyond populations in the U.S. South.

The researchers noted that the association between higher initial CD4 count and higher CKD risk is likely due to survival bias (increased life expectancy). Participants with an earlier year of HIV diagnosis may also have been exposed to older antiretroviral medications, some of which may have been associated with renal dysfunction.

The overall incidence rate of 12.39 per 1,000 person-years was reported in this study. The authors said, “This alarming incidence warns us of the importance of preventing CKD among PLWH, especially older PLWH.” Strategies for controlling diabetes, maintaining viral suppression, and keeping people in care need to be developed to prevent renal disease as PLWH age, they commented.

By Barbara Jungwirth