Factors associated to chronic kidney disease in people living with HIV/AIDS

a paired case-control study (4 controls for each case) carried out in a specialized care service in the Southeastern of Brazil, by analyzing PLHIV medical records. The sample consisted of 85 participants, corresponding to 17 cases and 68 controls. Pearson’s chi-square test (Χ²) and Fisher’s exact test, logistic regression, Odds Ratio (OR), 95% Confidence Interval (CI) and p<0.05 were used. SPSS version 25.0 and R Core Team, 2018 version 3.5.1 were used.

Results:

the factors associated with chronic kidney disease identified in this study were the following: presence of Systemic Arterial Hypertension [OR=5.8, CI (95%)=1.84-18.42, p=0.001] and use of nephrotoxic anti-retrovirals in the previous therapeutic regimen [OR=3.3, CI (95%)=1.105-10.221, p=0.028]. On the other hand, age below 40 years old [OR: 0.122, CI (95%)=0.015-0.981, p=0.022] was identified as a protective factor.

Conclusion:

the PLHIV under study have multi-factorial exposure associated with chronic kidney disease. However, knowing these factors helps to identify the existing risks and/or renal dysfunction, in addition to supporting the clinical decision of the health professionals who directly assist them.

Descriptors:
HIV; Renal Insufficiency, Chronic; Glomerular Filtration Rate; Antiretroviral Therapy, Highly Active; Risk Factors; Comorbidity

Variables	Cases		Controls
	Mean (SD^* * SD = Standard Deviation; )	Minimum-Maximum	Mean(SD^* * SD = Standard Deviation; )	Minimum-Maximum
Age	61.4 (9.3)	46-74.6	49.9 (10.8)	21.1-72.3
Time of HIV diagnosis	13.2 (6.5)	3.9-22.5	16.8 (6.7)	2.3-27.6
Time on ART^† † ART =Anti-Retroviral Therapy (total)	11.9 (7.4)	3.5-21.2	14.8 (6.3)	1.6-27.0
Time on ART^† † ART =Anti-Retroviral Therapy (current)	3.6 (2.9)	0.1-11.7	4.1 (3.0)	0.5-12.3
Time on ART^† † ART =Anti-Retroviral Therapy (previous)	8.3 (5.3)	0.8-17.0	9.8 (7.4)	0-22.4

CKD^* * CKD = Chronic Kidney Disease; stages	GFR^† † GFR=Glomerular Filtration Rate measured in ml/min/1.73 m2; ‡n1, ‡n2 and ‡n3 = Correspond respectively to the ante-penultimate, penultimate, and last number of people distributed in each GFR range of cases and controls	Case/Control
		n₁^‡ (%)		n₂^‡ (%)		n₃^‡(%)
1	≥90	1(5.8)	46(67.6)	1(5.8)	49(72.0)	-	51(75.0)
2	60-89	2(11.7)	22(32.4)	-	19(28.0)	1(5.8)	16 (23.5)
3A	45-59	7 (41.1)	-	11(64.7)	-	87(47.0)	1 (1.4)
3B	30-44	7(41.1)	-	4 (23.5)	-	4(23.5)	-
4	15-29	-	-	1(5.8)	-	4 (23.5)	-
5	-	-	-	-	-	-	-
	Total	17(100)	68(100)	17(100)	68(100)	17(100)	68(100)

Nephrotoxic anti-retrovirals	Case (n=17)		Control (n=68)
	n	%	n	%
Current use^* * Current use of one or more of a nephrotoxic anti-retroviral;
None	00	00	04	5.8
One	14	82.3	36	52.9
Two or more	03	17.6	28	41.1
Previous use^† † Previous use of one or more of a nephrotoxic anti-retroviral;
None	06	35.2	44	64.7
One	02	11.7	06	8.8
Two or more	09	52.9	18	26.4
Previous and current use^‡ ‡ Concomitant use of nephrotoxic anti-retrovirals
None	00	00	01	1.4
In both	11	64.7	24	35.2

Associated factors		Case	Control	Χ²^* * X2= Chi-square;	p value^† † p value = Significance value;	Gross OR^‡ ‡ OR = Odds Ratio;	Adjusted OR^‡ ‡ OR = Odds Ratio;	CI^§ § CI = Confidence Interval; ║ = Fisher’s Exact test. (95%)
Gender	Male	9	47	1.58	0.200	0.56	0.39	0.17-18.5
Gender	Female	8	21	1.58	0.200	0.56	0.39	0.17-18.5
Age group	<40 years old	1	23	5.240	0.022	0.12	11.42	0.015-0.981
Age group	>40 years old	16	45	5.240	0.022	0.12	11.42	0.015-0.981
Smoking	Yes	4	19	0.187	0.666	0.76	1.70	0.22-2.632
Smoking	No	13	47	0.187	0.666	0.76	1.70	0.22-2.632
Hepatitis B	Yes	0	3	0.777	1.0^║	0.79	NE^¶ ¶ NE = Not Estimated (the corresponding parameter was not estimated by the model due to the occurrence of numerical problems)	0.71-0.885
Hepatitis B	No	17	65	0.777	1.0^║	0.79		0.71-0.885
Hepatitis C	Yes	0	62	1.614	0.342^║	0.78	NE^¶ ¶ NE = Not Estimated (the corresponding parameter was not estimated by the model due to the occurrence of numerical problems)	0.699-0.881
Hepatitis C	No	17	6	1.614	0.342^║	0.78		0.699-0.881
Systemic Arterial Hypertension	Yes	9	11	10.21	0.001	5.83	8.37	1.84-18.42
Systemic Arterial Hypertension	No	8	57	10.21	0.001	5.83	8.37	1.84-18.42
Diabetes Mellitus	Yes	3	4	2.49	0.115	3.42	1.35	0.68-17.06
Diabetes Mellitus	No	14	64	2.49	0.115	3.42	1.35	0.68-17.06
Cardiovascular diseases	Yes	3	3	3.375	0.066	4.42	0.29	0.807-24.29
Cardiovascular diseases	No	14	62	3.375	0.066	4.42	0.29	0.807-24.29
Dyslipidemia	Yes	15	54	0.53	0.463	0.61	8.82	0.157-2.403
Dyslipidemia	No	2	13	0.53	0.463	0.61	8.82	0.157-2.403
Renal lithiasis	Yes	2	4	0.717	0.397	2.13	11.78	0.357-12.75
Renal lithiasis	No	15	64	0.717	0.397	2.13	11.78	0.357-12.75
Urinary tract infection	Yes	1	5	0.045	0.832	0.78	0.68	0.086-7.22
Urinary tract infection	No	16	63	0.045	0.832	0.78	0.68	0.086-7.22

Associated factors		Case	Control	Χ²^* * X2= Chi square;	p value^† † p value = Level of significance;	Gross OR^‡ ‡ OR = Odds Ratio;	Adjusted OR^‡ ‡ OR = Odds Ratio;	CI^§ § CI = Confidence Interval; (95%)
Time of HIV diagnosis	<5 years	5	19	0.015	0.904	1.07	1.18	0.333-3.462
Time of HIV diagnosis	≥5 years	12	49	0.015	0.904	1.07	1.18	0.333-3.462
Time of anti-retroviral therapy use	<5 years	8	28	0.087	0.768	1.17	0.97	0.402-3.429
Time of anti-retroviral therapy use	≥5 years	9	37	0.087	0.768	1.17	0.97	0.402-3.429
Viral load^║ ║ Last viral load test;	Undetectable	15	62	0.329	0.567	0.60	0.44	0.107-3.426
Viral load^║ ║ Last viral load test;	Detectable	2	5	0.329	0.567	0.60	0.44	0.107-3.426
Nephrotoxic anti-retrovirals (current) ^¶ ¶ Use of anti-retrovirals in current therapeutic regimen;	Yes	17	64	1.049	0.306^ Fisher’s exact test;	0.79	NE^†† †† NE = Not Estimated (the corresponding parameter was not estimated by the model due to the occurrence of numerical problems);	0.706-0.884
	No	0	4	1.049	0.306^ Fisher’s exact test;	0.79		0.706-0.884
Nephrotoxic anti-retrovirals (previous) ^‡‡ ‡‡ Use of anti-retrovirals in a previous therapeutic regimen	Yes	11	24	4.857	0.028	3.36	446099.48	1.105-10.221
	No	6	44	4.857	0.028	3.36	446099.48	1.105-10.221

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Priscila Silva Pontes E-mail: priscilapontes@usp.br