7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


MOPE082 Poster Exhibition

Incidence of end stage renal disease in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)

Presented by Keri Althoff (United States).

K. Althoff1, A. Abraham2, M. Estrella2, H.M. Crane3, A. Freeman2, M.J. Gill4, E.T. Golub2, M. Horberg5, L.P. Jacobson2, M.M. Kitahata3, R. McKaig6, F. Palella7, C.R. Parikh8, R.D. Moore2, Y. Jing2, B. Rodriguez9, J. Eron10, S. Napravnik10, M. Silverberg11, A. Mayor12, Z. Krishnasami13, G. Lucas2, North American AIDS Cohort Collaboration on Research and Design

1Johns Hopkins University, Epidemiology, Baltimore, United States, 2Johns Hopkins University, Baltimore, United States, 3University of Washington, Seattle, United States, 4University of Calgary, Calgary, Canada, 5Mid-Atlantic Kaiser Permanente Research Institute, Rockville, United States, 6National Institute of Allergy and Infectious Diseases, Bethesda, United States, 7Northwestern University, Chicago, United States, 8Yale University and the Veterans Affairs Connecticut Healthcare System, New Haven, United States, 9Case Western Reserve University, Cleveland, United States, 10University of North Carolina, Chapel Hill, United States, 11Kaiser Permanente Northern California, Oakland, United States, 12Universidad Central del Caribe, Bayamon, United States, 13University of Alabama, Birmingham, United States

Background: End stage renal disease (ESRD) is defined by the need for dialysis or renal transplantation (RT). The incidence of ESRD in HIV-infected adults has only been estimated in cohorts of limited size.
Methods: We identified individuals in 11 NA-ACCORD cohorts with two estimated glomular filtration rates < 30 ml/min/1.73m3 measured >90 days apart, or a diagnosis of renal disease from Jan 2000-Dec 2009. ESRD was validated through medical record evidence of dialysis or RT. Incidence rates (IR), adjusted rate ratios (aIRR) and 95% confidence intervals were estimated using Poisson regression models adjusted for age, sex, race, HIV transmission risk, treatment, AIDS, undetectable viral load, and CD4 count, all measured at study entry with the exception of age (which was time varying). Age-sex-race standardized incidence ratios (SIR) were estimated using rates from the United States Renal Database System.
Results: 37,073 adults contributed 306 ESRD events in 155,729 person years (PY), for an overall crude incidence of 197 [176, 220] per 100,000 PY. At study entry, 29% of study participants were ≥50-years-old, 79% were male, 33% were black, 47% were men who have sex with men (MSM), 22% had AIDS, and 53% were treatment-experienced. Crude incidence of ESRD can be seen in figure 1. Higher ESRD rates were seen with increasing age (18-39 years: aIRR=0.80 [0.58, 1.12]; 40-49 years: ref; 50-59 years: aIRR=1.39 [1.01, 1.90]; ≥60 years: 2.02 [1.29, 3.74]), among black adults (compared to white, aIRR=6.27 [4.23, 9.29]), persons with heterosexual HIV transmission risk (compared to MSM, aIRR=1.49 [1.50, 2.13]), treatment-experienced participants (aIRR=1.37 [1.04, 1.81]) and those with AIDS (aIRR=1.44 [1.10, 1.90]). The SIR was 3.65 [2.23, 4.06].
Conclusion: The incidence of ESRD was almost 4-fold higher in HIV-infected adults than the US general population, indicating the need for greater surveillance and treatment of contributing comorbidities among HIV-infected adults.

Figure1: Crude ESRD incidence rates per 100,000 PY
[Figure1: Crude ESRD incidence rates per 100,000 PY]

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