Background: Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown. Methods: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m2. Results: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI],. 68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI,. 24-.80]) vs 0.80 [95% CI,. 70-.93]). Conclusions: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.
The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study / L. Ryom, J.D. Lundgren, P. Reiss, M. Ross, O. Kirk, C.A. Fux, P. Morlat, E. Fontas, C. Smith, S. De Wit, A. D'Arminio Monforte, W. El Sadr, C. Hatleberg, A. Phillips, C. Sabin, M. Law, A. Mocroft. - In: THE JOURNAL OF INFECTIOUS DISEASES. - ISSN 0022-1899. - 223:4(2021), pp. 632-637. [10.1093/infdis/jiaa396]
The Impact of Immunosuppression on Chronic Kidney Disease in People Living with Human Immunodeficiency Virus: The D:A:D Study
A. D'Arminio Monforte;
2021
Abstract
Background: Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown. Methods: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m2. Results: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI],. 68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI,. 24-.80]) vs 0.80 [95% CI,. 70-.93]). Conclusions: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.
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