Immunodeficiency and renal impairment are risk factors for HIV-associated acute renal failure

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Objective:To identify risk factors for acute renal failure (ARF) in HIV-infected patients.Design:Observational cohort study of HIV-infected patients attending a South London HIV centre between January 1999 and December 2008.Methods:ARF was defined as a transient, more than 40% reduction in renal function as assessed by estimated glomerular filtration rate. Multivariate Poisson regression analysis was used to identify baseline and time-updated factors associated with ARF.Results:The incidence of ARF was 2.8 (95% confidence interval 2.41–3.24) episodes per 100 person-years. We observed a stepwise increase in ARF incidence with time accrued at lower CD4 cell count and at lower estimated glomerular filtration rate, with adjusted incidence rate ratios of 1 (reference), 1.56 (0.97–2.48), 2.08 (1.11–3.91), 6.38 (3.18–12.78) and 10.29 (5.11–20.98) for CD4 cell counts of more than 350, 201–350, 101–200, 51–100 and of 50/μl or less, and 1 (reference), 1.46 (0.86–2.51), 4.19 (2.37–7.42) and 27.00 (16.13–44.95) for estimated glomerular filtration rate more than 90, 75–89, 60–74 and less than 60 ml/min, respectively. Ethnicity, hepatitis B or C coinfection, exposure to combination antiretroviral therapy with or without indinavir, tenofovir or atazanavir and HIV viraemia were not associated with ARF.Conclusion:Current levels of immunodeficiency and renal function were independent predictors of HIV-associated ARF.

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