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Incidence of stage 3 chronic kidney disease and progression on tenofovir-based regimens : a cohort study in HIV-infected adults in Cape Town, South Africa
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Zachor, Hadas, Machekano, Rhoderick, Estrella, Michelle M., Veldkamp, Peter J., Zeier, Michele D., Uthman, Olalekan A., Taljaard, Jantjie J., Moosa, Mohammed R. and Nachega, Jean B. (2016) Incidence of stage 3 chronic kidney disease and progression on tenofovir-based regimens : a cohort study in HIV-infected adults in Cape Town, South Africa. Aids, 30 (8). pp. 1221-1228. doi:10.1097/QAD.0000000000001041 ISSN 0269-9370.
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Official URL: http://dx.doi.org/10.1097/QAD.0000000000001041
Abstract
Objective: To describe the incidence of rapid kidney function decline (RKFD), and stage 3 chronic kidney disease (CKD) in HIV-1-infected adults initiated on tenofovir (TDF)-containing antiretroviral therapy (ART).
Methods: A retrospective cohort study at the infectious diseases clinic of Tygerberg Academic Hospital in Cape Town, South Africa. Patients with >3 ml/min/year decline in estimated glomerular filtration (eGFR) were classified as having RKFD, and stage 3 CKD was defined as a value <60 ml/min/1.73 m2. We used logistic and Cox proportional hazards regression models to determine factors associated with RKFD and stage 3 CKD.
Results: Of 650 patients, 361 (55%) experienced RKFD and 15 (2%) developed stage 3 CKD during a median (interquartile range [IQR]) follow-up time of 54 (46.6-98) weeks. For every 10-year increase in age and 10 mL/min lower baseline eGFR, the odds of RKFD increased by 70% (adjusted odds ratio [aOR] = 1.70, 95% CI 1.36 to 2.13) and 57% (aOR = 1.57, 95% CI 1.38 to 1.80), respectively. Each 10-year older age was associated with a 1.90-fold increased risk of developing stage 3 CKD (adjusted HR [aHR] = 1.90, 95% CI: 1.10 to 3.29). Women had about 4-fold greater risk of stage 3 CKD compared to men (aHR = 3.96, 95% CI: 1.06 to 14.74).
Conclusions: About half of our study population developed RKFD but only 2% progressed to stage 3 CKD. Approaches that provide balanced allocation of limited resources towards screening and monitoring for kidney dysfunction and HIV disease management are critically needed in this setting.
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Aids | ||||
Publisher: | Lippincott Williams & Wilkins | ||||
ISSN: | 0269-9370 | ||||
Official Date: | 15 May 2016 | ||||
Dates: |
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Volume: | 30 | ||||
Number: | 8 | ||||
Page Range: | pp. 1221-1228 | ||||
DOI: | 10.1097/QAD.0000000000001041 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access | ||||
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