Kidney Week

Abstract: FR-OR014

Hospitalizations, AKI, and Longitudinal Kidney Function in HIV+ Patients

Session Information

• AKI: Epidemiology, Processes of Care, and Outcomes
  November 08, 2019 | Location: 201, Walter E. Washington Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Chilingirian, Ani, University of California, San Francisco, San Francisco, California, United States

Ani Chilingirian



Ani Chilingirian is a third-year UCSF medical student. She earned her bachelor’s degree in mathematics at the Massachusetts Institute of Technology and was inducted into the Phi Beta Kappa society. Her interests include healthcare informatics and technology. Ani is currently researching adverse kidney outcomes among HIV-positive patients.

• Muiru, Anthony N., University of California, San Francisco, San Francisco, California, United States

Anthony N. Muiru,

• Rubinsky, Anna, University of California, San Francisco, San Francisco, California, United States

Anna Rubinsky,

• Scherzer, Rebecca, UCSF, San Francisco, California, United States

Rebecca Scherzer,

• Madden, Erin, NCIRE, San Francisco, California, United States

Erin Madden,

• Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States

Jose Manuel Monroy-Trujillo,

• Moore, Richard, Johns Hopkins University, Baltimore, Maryland, United States

Richard Moore,

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh,

• Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States

Michael Shlipak,

• Estrella, Michelle M., University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, United States

Michelle M. Estrella,

Background

Whether AKI contributes to the excess CKD burden in HIV+ persons or simply marks poor overall health is unclear. We conducted a substudy in the Johns Hopkins HIV Clinical Cohort to examine if hospitalizations with and without AKI were each associated with longitudinal eGFR.

Methods

We included HIV+ persons followed from 1/2005-5/2016 and had baseline eGFR ≥15 ml/min, ≥3 eGFRs and sufficient creatinine (Cr) data to assess AKI status. We classified patients into 3 mutually exclusive groups: never hospitalized, hospitalized without AKI or hospitalized with AKI (≥0.3 mg/dL Cr rise within 48h or max inpatient Cr ≥50% above outpatient baseline). We used mixed effects models, adjusted for demographics, comorbidities, serum albumin, BMI, proteinuria, HIV factors and number of primary care visits.

Results

Among 1731 HIV+ persons, mean age was 43y, 77% were black, and 70% were on antiretrovirals at baseline. During a median follow-up of 3.7y, 730 had ≥1 hospitalization, of whom 43% had ≥1 complicated by AKI. Versus other groups, the hospitalized AKI group was more likely to have IV drug use history, greater comorbidity burden, lower CD4 count, less HIV suppression and lower mean eGFR at baseline (96 vs. 107-109 ml/min) at baseline. In adjusted models, there was little difference in annual eGFR change in those with non-AKI hospitalizations vs. no hospitalizations (△ 0.12 ml/min; 95%CI: -0.46, 0.71). Conversely, patients with hospitalized AKI vs. no hospitalizations had faster eGFR decline (△ -1.68 ml/min; 95%CI: -2.69, -0.67) (Figure). This association weakned in sensitivity analyses with inverse weighting for death (△ -0.85; 95%CI: -1.83, 0.14).

Conclusion

Hospitalized AKI is associated with faster kidney function decline, but hospitalization without AKI had no association. These findings underscore AKI as a potential pathway leading to CKD in HIV+ persons.[Figure]

Funding

• NIDDK Support