TY - JOUR
T1 - The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus
T2 - The D:A:D Study
AU - Ryom, L
AU - Lundgren, J D
AU - Reiss, P
AU - Ross, M
AU - Kirk, O
AU - Fux, C A
AU - Morlat, P
AU - Fontas, E
AU - Smith, C
AU - De Wit, S
AU - d'Arminio Monforte, A
AU - El Sadr, W
AU - Hatleberg, C
AU - Phillips, A
AU - Sabin, C
AU - Law, M
AU - Mocroft, A
AU - D:A:D Study Group
N1 - © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
PY - 2021/2/15
Y1 - 2021/2/15
N2 - BACKGROUND: Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown.METHODS: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m2.RESULTS: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24-.80]) vs 0.80 [95% CI, .70-.93]).CONCLUSIONS: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.
AB - BACKGROUND: Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown.METHODS: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m2.RESULTS: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24-.80]) vs 0.80 [95% CI, .70-.93]).CONCLUSIONS: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.
KW - CD4
KW - chronic kidney disease
KW - CKD
KW - eGFR
KW - HIV
KW - immunosuppression
KW - renal
UR - http://www.scopus.com/inward/record.url?scp=85102322122&partnerID=8YFLogxK
U2 - 10.1093/infdis/jiaa396
DO - 10.1093/infdis/jiaa396
M3 - Journal article
C2 - 32640015
SN - 0022-1899
VL - 223
SP - 632
EP - 637
JO - The Journal of infectious diseases
JF - The Journal of infectious diseases
IS - 4
ER -