Abstract: FR-PO386

Lipodystrophy Increases the Risk of Developing CKD in HIV-Infected Patients in Switzerland: the LIPOKID Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Bouatou, Yassine R., Geneva University Hospitals, Geneva, Switzerland
  • Gayet-Ageron, Angele, Geneva University Hospitals, Geneva, Switzerland
  • Calmy, Alexandra, Geneva University Hospitals, Geneva, Switzerland
  • De Seigneux, Sophie M., Geneva University Hospitals, Geneva, Switzerland

Group or Team Name

  • Swiss HIV Cohort Study
Background

Antiretroviral therapy (ART) improved HIV patient survival. However, metabolic complications such as dyslipidemia or lipodystrophy (LD) are the hallmark of first generation ART. Growing evidence points towards a role of lipid disturbances in chronic kidney disease (CKD). Also, as the HIV population is aging, identification of risk factors for (CKD) is crucial since both classical and HIV-related risk factors for CKD are highly prevalent among these patients. We studied the cumulative exposure to LD as an independent risk factor for CKD in HIV patients.

Methods

All patients from the Swiss HIV Cohort Study with an estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 at baseline (i.e. at entry in the cohort) and more than 3 months of follow-up from January 2002 to December 2015 were included. The primary endpoint was defined as a sustained eGFR < 60 ml/min/1.73 m2. The secondary endpoint was sustained albuminuria (dipstick). Cox regression models were used to measure the risk to develop CKD associated with cumulative exposure to different patterns of LD.

Results

Among the 5’384 patients included, 4’246 did not have LD at entry in the cohort. 31.0% developed at least once LD during their follow-up after a median time of 17.1 months (IQR: 0-45.2 months) and 252 (4.7%) reached the primary endpoint after a median follow-up time of 43.7 months from baseline (IQR: 18.5-89.3 months). Overall exposure to LD increased significantly the risk of an eGFR < 60 ml/min/1.73 m2 in univariate analysis with a hazard ratio (HR) 2.25 (95% confidence interval (CI): 1.68-3.00; p <0.001). After adjustment for main confounders, LD increased the risk of eGFR < 60 ml/min/1.73 m2 by a HR 1.98 (95% CI: 1.31-2.99; p = 0.001). LD was not significantly associated with the development of albuminuria.

Conclusion

LD might be a risk factor for eGFR decline independently of previously reported risk factors for CKD.