Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals

on behalf of the D:A:D study group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. Design: Prospective observational study. Methods: The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m2 or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m2), stabilization (-10 to +10 ml/min per 1.73 m2) and progression (<-10 ml/min per 1.73 m2). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression. Results: Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes. Conclusion: Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.

Original languageEnglish (US)
Pages (from-to)1261-1270
Number of pages10
JournalAIDS
Volume31
Issue number9
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Fingerprint

Glomerular Filtration Rate
HIV
Kidney
Tenofovir
Anti-HIV Agents
Ritonavir
Statistical Models
Observational Studies
Prospective Studies
Hypertension

Keywords

  • atazanavir
  • chronic renal impairment
  • estimated glomerular filtration rate
  • HIV
  • reversibility
  • tenofovir

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals. / on behalf of the D:A:D study group.

In: AIDS, Vol. 31, No. 9, 01.06.2017, p. 1261-1270.

Research output: Contribution to journalArticle

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title = "Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals",
abstract = "Objectives: The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. Design: Prospective observational study. Methods: The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m2 or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m2), stabilization (-10 to +10 ml/min per 1.73 m2) and progression (<-10 ml/min per 1.73 m2). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression. Results: Of 2006 individuals developing CRI, 21{\%} subsequently improved eGFR, 67{\%} stabilized and 12{\%} progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes. Conclusion: Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.",
keywords = "atazanavir, chronic renal impairment, estimated glomerular filtration rate, HIV, reversibility, tenofovir",
author = "{on behalf of the D:A:D study group} and Lene Ryom and Amanda Mocroft and Ole Kirk and Peter Reiss and Ross, {Michael J.} and Colette Smith and Olivier Moranne and Philippe Morlat and Fux, {Christoph A.} and Caroline Sabin and Andrew Phillips and Matthew Law and Lundgren, {Jens D.} and B. Powderly and N. Shortman and C. Moecklinghoff and G. Reilly and X. Franquet and Hatleberg, {C. I.} and L. Ryom and Sabin, {C. A.} and D. Kamara and C. Smith and A. Phillips and A. Mocroft and A. Bojesen and J. Nielsen and C. Matthews and D. Raben and Lundgren, {J. D.} and Brandt, {R. Salb{\o}l} and M. Rickenbach and I. Fanti and E. Krum and M. Hillebregt and S. Geffard and Jaohar Mourabi and A. Sundstr{\"o}m and M. Delforge and E. Fontas and F. Torres and H. McManus and S. Wright and J. Kj{\ae}r and Dennis Kristensen and A. Sj{\o}l and P. Meidahl and J. Helweg-Larsen and Iversen, {J. Schmidt} and L. Ryom",
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TY - JOUR

T1 - Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals

AU - on behalf of the D:A:D study group

AU - Ryom, Lene

AU - Mocroft, Amanda

AU - Kirk, Ole

AU - Reiss, Peter

AU - Ross, Michael J.

AU - Smith, Colette

AU - Moranne, Olivier

AU - Morlat, Philippe

AU - Fux, Christoph A.

AU - Sabin, Caroline

AU - Phillips, Andrew

AU - Law, Matthew

AU - Lundgren, Jens D.

AU - Powderly, B.

AU - Shortman, N.

AU - Moecklinghoff, C.

AU - Reilly, G.

AU - Franquet, X.

AU - Hatleberg, C. I.

AU - Ryom, L.

AU - Sabin, C. A.

AU - Kamara, D.

AU - Smith, C.

AU - Phillips, A.

AU - Mocroft, A.

AU - Bojesen, A.

AU - Nielsen, J.

AU - Matthews, C.

AU - Raben, D.

AU - Lundgren, J. D.

AU - Brandt, R. Salbøl

AU - Rickenbach, M.

AU - Fanti, I.

AU - Krum, E.

AU - Hillebregt, M.

AU - Geffard, S.

AU - Mourabi, Jaohar

AU - Sundström, A.

AU - Delforge, M.

AU - Fontas, E.

AU - Torres, F.

AU - McManus, H.

AU - Wright, S.

AU - Kjær, J.

AU - Kristensen, Dennis

AU - Sjøl, A.

AU - Meidahl, P.

AU - Helweg-Larsen, J.

AU - Iversen, J. Schmidt

AU - Ryom, L.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objectives: The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. Design: Prospective observational study. Methods: The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m2 or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m2), stabilization (-10 to +10 ml/min per 1.73 m2) and progression (<-10 ml/min per 1.73 m2). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression. Results: Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes. Conclusion: Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.

AB - Objectives: The objectives of this analysis were to investigate predictors of progression, stabilization or improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. Design: Prospective observational study. Methods: The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study participants progressing to CRI defined as confirmed, at least 3 months apart, and eGFR 70 ml/min per 1.73 m2 or less were included in the analysis. The median of all eGFRs measured 24-36 months post-CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min per 1.73 m2), stabilization (-10 to +10 ml/min per 1.73 m2) and progression (<-10 ml/min per 1.73 m2). Adjusted polynomial regression models assessed odds of better eGFR outcomes after CRI, assuming that eGFR improvement is better than stabilization which in turn is better than progression. Results: Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir (ATV/r) 24 months post-CRI had worse eGFR outcomes compared with those unexposed [TDF: 0.47 (0.35-0.63) and ATV/r: 0.63 (0.48-0.82)]. Individuals off TDF for 12-24 months [0.75 (0.50-1.13)] or off ATV/r for more than 12 months [1.17 (0.87-1.57)] had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes. Conclusion: Current TDF and ATV/r use after a diagnosis of CRI was associated with worse eGFR outcomes. In contrast, TDF and ATV/r discontinuation lead to similar longer term eGFR outcomes as in those unexposed, suggesting that these drug-associated eGFR declines may be halted or reversed after their cessation.

KW - atazanavir

KW - chronic renal impairment

KW - estimated glomerular filtration rate

KW - HIV

KW - reversibility

KW - tenofovir

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U2 - 10.1097/QAD.0000000000001464

DO - 10.1097/QAD.0000000000001464

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VL - 31

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EP - 1270

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JF - AIDS

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