Función renal en pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de cohorte

Abstract

ABSTRACT Background and Objectives: As the prognosis of patients with human immunodeficiency virus infection improved, various comorbidities gain greater importance, including chronic kidney failure. The prevalence of chronic kidney failure vary from 2 to 30% in published studies, this variability depends on the methodology and the composition of the cohort studied. Various factors have been associated with chronic kidney failure. The objectives of the study are to estimate the prevalence and incidence of chronic kidney failure in patients with HIV infection in our environment, to study the associated factors and the influence of drugs. Methods and Results: We analysed a cohort of 754 patients with a median follow-up of 9 years. We estimated glomerular filtration using the CKDepi equation and defined chronic renal failure as a glomerular filtration less than 60 mL/min at least in two determinations separated by 3 months. Estimated prevalence of chronic kidney failure is 2.46 percent (95%CI: 2,21-2,70) and incidence is 3,14 cases per 1000 patients per year. We study factors associated with chronic kidney failure using a logistic regression model and new appearance chronic kidney failure using a Cox regression model. Independently associated factors are age and diabetes mellitus. We found no association with exposure to drugs. For the study of episodes of impairment of renal function that do not lead to chronic renal failure we carry out an analysis by semesters of follow-up. We count the episodes of worsening renal function that occur in each semester and the variables present in each period using a Poisson regression. In this analysis, exposure to tenofovir disoproxil fumarate alone or with protease inhibitor is a factor associated with episodes of impaired renal function. Conclusion: Chronic kidney failure in patients with human immunodeficiency virus infection is associated to traditional risk factors as age and diabetes mellitus. Exposure to drugs such as tenofovir disoproxil fumarate alone or with protease inhibitor is associated with impairment of renal function episodes that do not produce a chronic renal failure. Chronic renal failure is associated with an increase in mortality.