The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study

Lene Ryom; Jens D. Lundgren; Peter Reiss; Mike Ross; Ole Kirk; Christophe A. Fux; Phillipe Morlat; Eric Fontas; Colette Smith; Stephane De Wit; Antonella D'Arminio Monforte; Wafaa El Sadr; Camilla Hatleberg; Andrew Phillips; Caroline Sabin; Matthew Law; Amanda Mocroft

doi:10.1093/infdis/jiaa396

The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study

Lene Ryom, Jens D. Lundgren, Peter Reiss, Mike Ross, Ole Kirk, Christophe A. Fux, Phillipe Morlat, Eric Fontas, Colette Smith, Stephane De Wit, Antonella D'Arminio Monforte, Wafaa El Sadr, Camilla Hatleberg, Andrew Phillips, Caroline Sabin, Matthew Law, Amanda Mocroft

Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	632-637
Number of pages	6
Journal	Journal of Infectious Diseases
Volume	223
Issue number	4
DOIs	https://doi.org/10.1093/infdis/jiaa396
State	Published - Feb 15 2021

Keywords

CD4
CKD
HIV
chronic kidney disease
eGFR
immunosuppression
renal

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Ryom, L., Lundgren, J. D., Reiss, P., Ross, M., Kirk, O., Fux, C. A., Morlat, P., Fontas, E., Smith, C., De Wit, S., D'Arminio Monforte, A., El Sadr, W., Hatleberg, C., Phillips, A., Sabin, C., Law, M., & Mocroft, A. (2021). The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study. Journal of Infectious Diseases, 223(4), 632-637. https://doi.org/10.1093/infdis/jiaa396

Ryom, L, Lundgren, JD, Reiss, P, Ross, M, Kirk, O, Fux, CA, Morlat, P, Fontas, E, Smith, C, De Wit, S, D'Arminio Monforte, A, El Sadr, W, Hatleberg, C, Phillips, A, Sabin, C, Law, M & Mocroft, A 2021, 'The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study', Journal of Infectious Diseases, vol. 223, no. 4, pp. 632-637. https://doi.org/10.1093/infdis/jiaa396

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abstract = "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.",

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AU - Ross, Mike

AU - Kirk, Ole

AU - Fux, Christophe A.

AU - Morlat, Phillipe

AU - Fontas, Eric

AU - Smith, Colette

AU - De Wit, Stephane

AU - D'Arminio Monforte, Antonella

AU - El Sadr, Wafaa

AU - Hatleberg, Camilla

AU - Phillips, Andrew

AU - Sabin, Caroline

AU - Law, Matthew

AU - Mocroft, Amanda

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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.

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The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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