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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Pages (from-to)632-637
Number of pages6
JournalJournal of Infectious Diseases
Volume223
Issue number4
DOIs
StatePublished - Feb 15 2021

Keywords

  • CD4
  • CKD
  • HIV
  • chronic kidney disease
  • eGFR
  • immunosuppression
  • renal

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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