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Renal failure in HIV-positive patients—a South African experience

BACKGROUND: Kidney disease is a major complication of HIV infection, with both acute kidney injury (AKI) and chronic kidney disease (CKD) contributing to morbidity and mortality. Incidence of AKI was reported as 5.9 per 100 patient years in ambulatory patients and ∼18% in hospitalized HIV-infected p...

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Autores principales: Vachiat, Ahmed Ismail, Musenge, Eustasius, Wadee, Shoyab, Naicker, Saraladevi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438376/
https://www.ncbi.nlm.nih.gov/pubmed/26069826
http://dx.doi.org/10.1093/ckj/sft128
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author Vachiat, Ahmed Ismail
Musenge, Eustasius
Wadee, Shoyab
Naicker, Saraladevi
author_facet Vachiat, Ahmed Ismail
Musenge, Eustasius
Wadee, Shoyab
Naicker, Saraladevi
author_sort Vachiat, Ahmed Ismail
collection PubMed
description BACKGROUND: Kidney disease is a major complication of HIV infection, with both acute kidney injury (AKI) and chronic kidney disease (CKD) contributing to morbidity and mortality. Incidence of AKI was reported as 5.9 per 100 patient years in ambulatory patients and ∼18% in hospitalized HIV-infected patients, an almost 3-fold higher risk compared with HIV uninfected patients in developed countries. CKD was reported in 6–48.5% of HIV-infected patients in Africa. There is a paucity of data regarding the prevalence and outcomes of AKI in HIV-infected patients in sub-Saharan Africa, the region most affected by HIV. METHODS: A retrospective review of 101 HIV-positive anti-retroviral therapy (ART)-naïve patients presenting with renal failure from 1 October 2005 to 30 September 2006 was undertaken. RESULTS: A total of 684 patients presented with renal failure, 101 (14.8%) of whom were HIV positive. Ninety-nine (98%) of HIV-positive patients were black and 56 (55%) were male, with mean age 38 ± 9.9 years (range 21–61 years). HIV-positive patients demonstrated severe immunosuppression, with mean CD(4) count of 135 cells/µL (range 1–579 cells/µL). Fifty-seven (56%) HIV-positive patients presented with AKI, 21 (21%) with acute-on-chronic kidney disease and 23 (23%) with CKD; seven patients with AKI were excluded due to lack of records. The causes of AKI in the HIV-positive group included sepsis (60%), volume depletion and haemodynamic instability (19%), toxins (9%), urological obstruction (7%) and miscellaneous (14%). Forty-four per cent of HIV-positive and 47% of HIV-negative patients with AKI demised; P = 0.45. Hyponatraemia (P = 0.018), acidosis (P = 0.018), anaemia (P = 0.019) and hyperphosphataemia (P = 0.003) were predictors of mortality in HIV-positive patients with AKI. In comparison, predictors of mortality in the HIV-negative group were age (P = 0.023) and black ethnicity (P = 0.04). CONCLUSION: HIV-positive patients, compared with the HIV-negative group, presented with AKI at a younger age and at an advanced stage of immunosuppression. Appropriate support, including dialysis, resulted in similar outcomes in both groups.
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spelling pubmed-44383762015-06-11 Renal failure in HIV-positive patients—a South African experience Vachiat, Ahmed Ismail Musenge, Eustasius Wadee, Shoyab Naicker, Saraladevi Clin Kidney J Original Contributions BACKGROUND: Kidney disease is a major complication of HIV infection, with both acute kidney injury (AKI) and chronic kidney disease (CKD) contributing to morbidity and mortality. Incidence of AKI was reported as 5.9 per 100 patient years in ambulatory patients and ∼18% in hospitalized HIV-infected patients, an almost 3-fold higher risk compared with HIV uninfected patients in developed countries. CKD was reported in 6–48.5% of HIV-infected patients in Africa. There is a paucity of data regarding the prevalence and outcomes of AKI in HIV-infected patients in sub-Saharan Africa, the region most affected by HIV. METHODS: A retrospective review of 101 HIV-positive anti-retroviral therapy (ART)-naïve patients presenting with renal failure from 1 October 2005 to 30 September 2006 was undertaken. RESULTS: A total of 684 patients presented with renal failure, 101 (14.8%) of whom were HIV positive. Ninety-nine (98%) of HIV-positive patients were black and 56 (55%) were male, with mean age 38 ± 9.9 years (range 21–61 years). HIV-positive patients demonstrated severe immunosuppression, with mean CD(4) count of 135 cells/µL (range 1–579 cells/µL). Fifty-seven (56%) HIV-positive patients presented with AKI, 21 (21%) with acute-on-chronic kidney disease and 23 (23%) with CKD; seven patients with AKI were excluded due to lack of records. The causes of AKI in the HIV-positive group included sepsis (60%), volume depletion and haemodynamic instability (19%), toxins (9%), urological obstruction (7%) and miscellaneous (14%). Forty-four per cent of HIV-positive and 47% of HIV-negative patients with AKI demised; P = 0.45. Hyponatraemia (P = 0.018), acidosis (P = 0.018), anaemia (P = 0.019) and hyperphosphataemia (P = 0.003) were predictors of mortality in HIV-positive patients with AKI. In comparison, predictors of mortality in the HIV-negative group were age (P = 0.023) and black ethnicity (P = 0.04). CONCLUSION: HIV-positive patients, compared with the HIV-negative group, presented with AKI at a younger age and at an advanced stage of immunosuppression. Appropriate support, including dialysis, resulted in similar outcomes in both groups. Oxford University Press 2013-12 2013-11-07 /pmc/articles/PMC4438376/ /pubmed/26069826 http://dx.doi.org/10.1093/ckj/sft128 Text en © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: journals.permissions@oup.com. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Contributions
Vachiat, Ahmed Ismail
Musenge, Eustasius
Wadee, Shoyab
Naicker, Saraladevi
Renal failure in HIV-positive patients—a South African experience
title Renal failure in HIV-positive patients—a South African experience
title_full Renal failure in HIV-positive patients—a South African experience
title_fullStr Renal failure in HIV-positive patients—a South African experience
title_full_unstemmed Renal failure in HIV-positive patients—a South African experience
title_short Renal failure in HIV-positive patients—a South African experience
title_sort renal failure in hiv-positive patients—a south african experience
topic Original Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438376/
https://www.ncbi.nlm.nih.gov/pubmed/26069826
http://dx.doi.org/10.1093/ckj/sft128
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