Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV
Por:
Bonjoch, A, Juega, J, Echeverria, P, Puig, J, Perez-Alvarez, N, Bonal, J, Loste, C, Clotet, B and Negredo, E
Publicada:
1 nov 2022
Ahead of Print:
1 abr 2022
Resumen:
Background Advanced kidney disease is an emerging problem in people living with HIV despite sustained viral suppression. Methods We performed a prospective cohort study to identify people living with HIV with advanced kidney disease according to the Kidney Disease Improving Global Outcomes criteria and to assess disease progression over a 48-week period following the offer of targeted multidisciplinary management. Results From our cohort of 3090 individuals, 55 (1.8%, 95% confidence interval [CI] 1.31-2.25) fulfilled the inclusion criteria. Most were male (83.6%), and the median (interquartile range [IQR]) age was 58 (53.25-66.75) years. Nadir CD4 T-cell count was 135.5 (IQR 43.5-262.75) cells/mu l, current CD4 T-cell count was 574 (IQR 438.5-816) cells/mu l, and 96% had maintained HIV viral suppression. The most frequent comorbidity was arterial hypertension (85.5%). Inadequate antiretroviral dose was detected in three individuals (5.5%), and drug-drug interactions were recorded in eight (14.5%), mainly involving the use of cobicistat (n = 5 [9%]). Four individuals (7%) required modification of their concomitant treatment. Seven (13%) had to start or resume follow-up with a nephrologist. Nine participants (16.4%) experienced an improvement in kidney disease stage, three individuals (5.5%) underwent renal transplantation, and one (2%) started haemodialysis. Conclusions Our results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug-drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease.
Filiaciones:
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
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Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Nephrol Dept, Badalona, Spain
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
Tech Univ Catalonia, Dept Stat & Operat Res, Barcelona Tech, Barcelona, Spain
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Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Nephrol Dept, Badalona, Spain
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
Cent Univ Catalonia UVic UCC, Fac Med, Ctr Hlth & Social Care Res CESS, Infect Dis & Immun,Univ Vic, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, AIDS Res Inst IrsiCaixa, Badalona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
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Univ Autonoma Barcelona, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Lluita Sida Fdn, Badalona, Spain
Cent Univ Catalonia UVic UCC, Fac Med, Ctr Hlth & Social Care Res CESS, Infect Dis & Immun,Univ Vic, Barcelona, Spain
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