ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-OR014

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

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Chilingirian, Ani, University of California, San Francisco, San Francisco, California, United States
  • Muiru, Anthony N., University of California, San Francisco, San Francisco, California, United States
  • Rubinsky, Anna, University of California, San Francisco, San Francisco, California, United States
  • Scherzer, Rebecca, UCSF, San Francisco, California, United States
  • Madden, Erin, NCIRE, San Francisco, California, United States
  • Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States
  • Moore, Richard, Johns Hopkins University, Baltimore, Maryland, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States
  • Estrella, Michelle M., University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, United States
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