Evolution of kidney function after five years of follow-up in a large Spanish cohort of patients with HIV: risk factors for progression.

BACKGROUND

Antiretroviral therapy has improved life expectancy in HIV patients; however the increase in longevity has led to comorbidities, with chronic kidney disease (CKD) being especially concerning. CKD may evolve into end-stage kidney disease and, in the worst severe cases, these condition may lead to mortality. In this context, it is important to identify the patients at risk of CKD progression and to characterize the associated risk factors.

METHODS

A retrospective observational study (2014–2019) was conducted in people living with HIV enrolled in a Spanish cohort. We analyzed the CKD prevalence and its progression after five years of follow-up, considering predictive factors.

RESULTS

The prevalence of CKD increased from 2.83% in 2014 to 7.94% in 2019. Among patients without CKD at baseline, 43.4% progressed to mild kidney disease (MKD), and 19% developed CKD after five years. Multivariate analysis identified age as the strongest independent factor for CKD, with rates increasing from 14.3% in 2014 to 32.1% in 2019, among individuals older than 64 years. The addition of the proteinuria as a biomarker only helped us to identify 7% of patients who evolved to MKD and 30% of patients who progressed to CKD.

CONCLUSIONS

This study confirms the increased risk of developing CKD in a Spanish HIV cohort after five years of follow up, with age as the strongest risk factor. Furthermore, proteinuria is an unable biomarker to assess the full risk of CKD stage progression, as it only identifies a small proportion of patients who progressed. This finding highlights the need to identify novel biomarkers to improve the assessment of the risk of CKD stage progression in this population.