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Abstract: TH-OR03

The Incidence and Risk Factors of AKI Among People with HIV on Antiretroviral Treatment

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
  • Madden, Erin, Northern California Institute for Research and Education, San Francisco, California, United States
  • Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States
  • Parikh, Chirag R., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
Background

The epidemiology of hospitalized acute kidney injury (AKI) among people with HIV (PWH) in the era of modern antiretroviral therapy for all PWH is not well-characterized.

Methods

We evaluated the incidence and risk factors for hospitalized AKI from 2005-2015 in a prospective study of PWH from the Johns Hopkins HIV Clinical Cohort. We defined hospitalized AKI as ≥0.3 mg/dL rise in serum creatinine (SCr) within any 48-hour period or 50% increase in SCr from baseline and assessed associations of risk factors with incident AKI using multivariate Cox regression models.

Results

Most participants (75%) were Black, 34% were female, mean age was 43 years and mean eGFR 106 mL/min/1.73 m2. The incidence of AKI fluctuated annually, peaking at 40 per 1,000 person-years (PY) (95% CI: 22-69) in 2007, and reached a nadir of 20 per 1,000 PY (95% CI: 11-34) in 2010 (Figure). After multivariable adjustment, characteristics independently associated with AKI included Black race (HR=2.44; 95% CI: 1.42-4.20), hypertension (HR=1.61; 95% CI: 1.09-2.38), dipstick proteinuria >1+ (HR=1.78; 95% CI:1.06-2.97), history of AIDS (HR=1.82; 95% CI: 1.29-2.56), CD4 count <200 cells/mm3 (HR=1.46; 95% CI: 1.02-2.07), and lower serum albumin (HR=2.87 per 0.1 mg/dL; 95% CI: 2.78-2.97).

Conclusion

In this contemporary cohort of PWH, the annual incidence of first AKI fluctuated during the study period. Attention to modifiable AKI risk factors and social determinants of health may further reduce AKI incidence among PWH.

Funding

  • NIDDK Support