Comorbid diabetes and the risk of progressive chronic kidney disease in HIV-infected adults: Data from the Veterans Aging Cohort Study

• Type of Material: Article
• Authors: Raj Medapalli, Mount Sinai School of Medicine; Chirag R. Parikh, Yale University; Kirsha Gordon, VA Healthcare Systems West Haven; Sheldon T. Brown, James J. Peters VA Medical Center; Adeel A. Butt, VA Pittsburgh Healthcare System; Cynthia L. Gibert, VA Medical Center; David Rimland, Emory University; Maria C. Rodriguez-Barradas, Michael E DeBakey VA Medical Center; Chung-Chou Chang, University of Pittsburgh; Amy C. Justice, West Haven VA Medical Center; John Chijiang He, Mount Sinai School of Medicine; Christina M. Wyatt, Mount Sinai School of Medicine
• Language: English
• Date: 2012-08-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 by Lippincott Williams & Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0b013e31825b70d9
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 60
• Issue: 4
• Start Page: 393
• End Page: 399
• Grant/Funding Information: This work was also supported in part by the National Institute of Diabetes and Digestive and Kidney Disease (P01DK056492, R01DK088541, R01DK078897, and K23DK077568).; The Veterans Aging Cohort Study is supported by the National Institutes of Health, National Institute of Alcohol and Alcohol Abuse (U01 AA13566) and by the Office of Research and Development, Department of Veterans Affairs.
• Keywords: Infectious Diseases; risk factors; RATES; Science & Technology; non-AIDS complications; Immunology; HEPATITIS-C; diabetes; GLOMERULAR-FILTRATION-RATE; CORONARY-HEART-DISEASE; ANTIRETROVIRAL THERAPY; HIV; MELLITUS; DATA-COLLECTION; Life Sciences & Biomedicine; ADVERSE EVENTS; chronic kidney disease
• Research Categories: Health Sciences, General; Health Sciences, Immunology

Abstract

Introduction: Approximately, 15% of HIV-infected individuals have comorbid diabetes. Studies suggest that HIV and diabetes have an additive effect on chronic kidney disease (CKD) progression; however, this observation may be confounded by differences in traditional CKD risk factors. Methods: We studied a national cohort of HIV-infected and matched HIV-uninfected individuals who received care through the Veterans Healthcare Administration. Subjects were divided into 4 groups based on baseline HIV and diabetes status, and the rate of progression to an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m was compared using Cox-proportional hazards modeling to adjust for CKD risk factors. Results: About 31,072 veterans with baseline eGFR ≥45 mL/min/1.73m 2 (10,626 with HIV only, 5088 with diabetes only, and 1796 with both) were followed for a median of 5 years. Mean baseline eGFR was 94 mL/min/1.73m 2 , and 7% progressed to an eGFR < 45 mL/min/1.73m 2 . Compared with those without HIV or diabetes, the relative rate of progression was increased in individuals with diabetes only [adjusted hazard ratio (HR) 2.48; 95% confidence interval (CI): 2.19 to 2.80], HIV only [HR: 2.80, 95% CI: 2.50 to 3.15] , and both HIV and diabetes [HR: 4.47, 95% CI: 3.87 to 5.17]. DISCUSSION:: Compared with patients with only HIV or diabetes, patients with both diagnoses are at significantly increased risk of progressive CKD even after adjusting for traditional CKD risk factors. Future studies should evaluate the relative contribution of complex comorbidities and accompanying polypharmacy to the risk of CKD in HIV-infected individuals and prospectively investigate the use of cART, glycemic control, and adjunctive therapy to delay CKD progression.