Factores de riesgo asociados a enfermedad renal crónica en pacientes con infección por VIH

Heriberto José Cabrales Dajil, Fernando De la Vega del Risco, Jorge Coronado Daza

DOI: https://doi.org/10.32997/rcb-2019-2874

Resumen

Introducción: Los avances en la terapia antirretroviral han convertido la infección por VIH en una enfermedad crónica, en consecuencia, se han tornado relevantes patologías relacionadas con el virus, el tratamiento y el envejecimiento, una de ellas es la Enfermedad Renal Crónica (ERC), cuya prevalencia se ha incrementado.  

Objetivo: Establecer factores de riesgo asociados al desarrollo de ERC, en pacientes infectados por VIH, en terapia antirretroviral de gran actividad, en la ciudad de Cartagena.

Métodos: Se realizó un estudio de corte transversal, con pacientes asistentes a terapia antirretroviral, entre enero y diciembre de 2017. La función renal fue determinada por Tasa de Filtración Glomerular Estimada (TFGe) mediante ecuación CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) y determinación de albuminuria por cuantificación de relación albumina y creatinina en orina aislada. La ERC se definió como una TFGe menor o igual a 60 ml/min/1,73m2, por un período de, al menos, tres meses. Se utilizó un modelo de regresión logística para estimar los efectos de diversas variables en el desarrollo de ERC.

Resultados: Fueron incluidos 267 pacientes, mediana de edad 41 años, mediana del tiempo desde el diagnóstico de VIH, y duración de la TARGA de 4,8 y 4,5 años, respectivamente. Prevalencia de HTA de 8.2% y Diabetes mellitus de 2.9%. La ERC fue diagnosticada en 3.7% de la población y luego del ajuste, el factor de riesgo asociado fue la edad ≥52 años (OR=14,04 (IC 95% 2,90 – 67,95)).

Conclusiones: La prevalencia de ERC en pacientes infectados con VIH es alta, con respecto a la población general. La edad se encontró relacionada al desarrollo de ERC.


Palabras clave

Enfermedad renal crónica; VIH; nefrotoxicidad

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Referencias

Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV medicine. 2017;18(4):256-66.

Justice AC, Dombrowski E, Conigliaro J, Fultz SL, Gibson D, Madenwald T, et al. Veterans Aging Cohort Study (VACS): Overview and Description. Medical care. 2006;44(8 Suppl 2):S13-S24.

Wyatt CM, Winston JA, Malvestutto CD, Fishbein DA, Barash I, Cohen AJ, et al. Chronic kidney disease in HIV infection: an urban epidemic. Aids. 2007;21(15):2101-3.

Helleberg M, May MT, Ingle SM, Dabis F, Reiss P, Fatkenheuer G, et al. Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. Aids. 2015;29(2):221-9.

Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem Av, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. The Lancet Infectious Diseases. 2015;15(7):810-8.

Palella FJ, Jr., Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. Journal of acquired immune deficiency syndromes (1999). 2006;43(1):27-34.

Yang CH, Huang YF, Hsiao CF, Yeh YL, Liou HR, Hung CC, et al. Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984-2005. HIV medicine. 2008;9(7):535-43.

Martinez E, Milinkovic A, Buira E, de Lazzari E, Leon A, Larrousse M, et al. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV medicine. 2007;8(4):251-8.

Ehren K, Hertenstein C, Kummerle T, Vehreschild JJ, Fischer J, Gillor D, et al. Causes of death in HIV-infected patients from the Cologne-Bonn cohort. Infection. 2014;42(1):135-40.

Kaufman L, Collins SE, Klotman PE. The pathogenesis of HIV-associated nephropathy. Advances in chronic kidney disease. 2010;17(1):36-43.

Stokes MB, Chawla H, Brody RI, Kumar A, Gertner R, Goldfarb DS, et al. Immune complex glomerulonephritis in patients coinfected with human immunodeficiency virus and hepatitis C virus. American journal of kidney diseases : the official journal of the National Kidney Foundation. 1997;29(4):514-25.

Peters L, Grint D, Lundgren JD, Rockstroh JK, Soriano V, Reiss P, et al. Hepatitis C virus viremia increases the incidence of chronic kidney disease in HIV-infected patients. Aids. 2012;26(15):1917-26.

Suzuki S, Nishijima T, Kawasaki Y, Kurosawa T, Mutoh Y, Kikuchi Y, et al. Effect of Tenofovir Disoproxil Fumarate on Incidence of Chronic Kidney Disease and Rate of Estimated Glomerular Filtration Rate Decrement in HIV-1-Infected Treatment-Naive Asian Patients: Results from 12-Year Observational Cohort. AIDS patient care and STDs. 2017;31(3):105-12.

Achhra AC, Mocroft A, Ross MJ, Ryom L, Lucas GM, Furrer H, et al. Kidney disease in antiretroviral-naive HIV-positive adults with high CD4 counts: prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV medicine. 2015;16 Suppl 1:55-63.

Mocroft A, Kirk O, Gatell J, Reiss P, Gargalianos P, Zilmer K, et al. Chronic renal failure among HIV-1-infected patients. Aids. 2007;21(9):1119-27.

Crum-Cianflone N, Ganesan A, Teneza-Mora N, Riddle M, Medina S, Barahona I, et al. Prevalence and factors associated with renal dysfunction among HIV-infected patients. AIDS patient care and STDs. 2010;24(6):353-60.

Mocroft A, Kirk O, Reiss P, De Wit S, Sedlacek D, Beniowski M, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. Aids. 2010;24(11):1667-78.

Moso MA, Woolnough E, Langham F, Hoy JF, Cheng AC, Walker RG, et al. Increasing prevalence and risk of chronic kidney disease in HIV-positive individuals: changing demographics over a six-year period. The Journal of infectious diseases. 2017.

Calza L, Vanino E, Magistrelli E, Salvadori C, Cascavilla A, Colangeli V, et al. Prevalence of renal disease within an urban HIV-infected cohort in northern Italy. Clinical and Experimental Nephrology. 2014;18(1):104-12.

Otero A, de Francisco A, Gayoso P, Garcia F. Prevalence of chronic renal disease in Spain: results of the EPIRCE study. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia. 2010;30(1):78-86.

Social MdSyP. ANALISIS DE SITUACIÓN DE SALUD (ASIS) COLOMBIA. Disponible en: https://wwwminsaludgovco/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/asis-colombia-2016pdf. 2016.

Nishijima T, Kawasaki Y, Mutoh Y, Tomonari K, Tsukada K, Kikuchi Y, et al. Prevalence and factors associated with chronic kidney disease and end-stage renal disease in HIV-1-infected Asian patients in Tokyo. Scientific reports. 2017;7(1):14565.

Mallipattu SK, Salem F, Wyatt CM. The changing epidemiology of HIV-related chronic kidney disease in the era of antiretroviral therapy. Kidney Int. 2014;86(2):259-65.

Ikpeme EE, Ekrikpo UE, Akpan MU, Ekaidem SI. Determining the prevalence of human immunodeficiency virus-associated nephropathy (HIVAN) using proteinuria and ultrasound findings in a Nigerian paediatric HIV population. The Pan African medical journal. 2012;11:13.

Scherzer R, Estrella M, Li Y, Choi AI, Deeks SG, Grunfeld C, et al. Association of tenofovir exposure with kidney disease risk in HIV infection. Aids. 2012;26(7):867-75.

Rho M, Perazella MA. Nephrotoxicity associated with antiretroviral therapy in HIV-infected patients. Current drug safety. 2007;2(2):147-54.

Goicoechea M, Liu S, Best B, Sun S, Jain S, Kemper C, et al. Greater tenofovir-associated renal function decline with protease inhibitor-based versus nonnucleoside reverse-transcriptase inhibitor-based therapy. The Journal of infectious diseases. 2008;197(1):102-8.

Mocroft A, Lundgren JD, Ross M, Fux CA, Reiss P, Moranne O, et al. Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: a prospective international cohort study. The lancet HIV. 2016;3(1):e23-32.

Kalayjian RC, Lau B, Mechekano RN, Crane HM, Rodriguez B, Salata RA, et al. Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care. AIDS (London, England). 2012;26(15):1907-15.

Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clinical chemistry. 1992;38(10):1933-53.

Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28(5):830-8.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of internal medicine. 1999;130(6):461-70.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Annals of internal medicine. 2009;150(9):604-12.

Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, et al. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clinical chemistry. 2007;53(4):766-72.

Vrouenraets SM, Fux CA, Wit FW, Garcia EF, Brinkman K, Hoek FJ, et al. A comparison of measured and estimated glomerular filtration rate in successfully treated HIV-patients with preserved renal function. Clinical nephrology. 2012;77(4):311-20.

Cristelli MP, Cofan F, Rico N, Trullas JC, Manzardo C, Aguero F, et al. Estimation of renal function by CKD-EPI versus MDRD in a cohort of HIV-infected patients: a cross-sectional analysis. BMC nephrology. 2017;18(1):58.

Gagneux-Brunon A, Botelho-Nevers E, Delanaye P, Lucht F, Fresard A, Cazorla C, et al. CKD-EPI equation: A suitable Glomerular Filtration Rate estimate for drug dosing in HIV-infected patients. Medecine et maladies infectieuses. 2017.

Okparavero AA, Tighiouart H, Krishnasami Z, Wyatt CM, Graham H, Hellinger J, et al. Use of glomerular filtration rate estimating equations for drug dosing in HIV-positive patients. Antiviral therapy. 2013;18(6):793-802.

Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK, et al. Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected With HIV: 2014 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2014;59(9):e96-e138.

Andrassy KM. Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'. Kidney Int. 2013;84(3):622-3.

Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Annals of internal medicine. 2013;158(11):825-30.

Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2014;63(5):713-35.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289(19):2560-72.

2. Classification and Diagnosis of Diabetes. Diabetes care. 2017;40(Suppl 1):S11-s24.

Diaz K. PREVALENCIA DE ALTERACIÓN RENAL EN UNA POBLACIÓN AMBULATORIA CON VIH-SIDA DE CARTAGENA (TRABAJO DE GRADO). Universidad de Cartagena, Bolívar, Colombia. 2009.

Costo FCdEdA. Situación de la Enfermedad Renal Crónica, la hipertensión arterial y la diabetes mellitus en Colombia 2016. Cuenta de Alto Costo. 2017:57,107.

Lamb EJ, O'Riordan SE, Delaney MP. Kidney function in older people: pathology, assessment and management. Clin Chim Acta. 2003;334(1-2):25-40.

Lucas GM, Lau B, Atta MG, Fine DM, Keruly J, Moore RD. Chronic Kidney Disease Incidence, and Progression to End-Stage Renal Disease, in HIV-Infected Individuals: A Tale of Two Races. The Journal of infectious diseases. 2008;197(11):1548-57.

Overton ET, Nurutdinova D, Freeman J, Seyfried W, Mondy KE. Factors associated with renal dysfunction within an urban HIV-infected cohort in the era of highly active antiretroviral therapy. HIV medicine. 2009;10(6):343-50.

Fernando SK, Finkelstein FO, Moore BA, Weissman S. Prevalence of chronic kidney disease in an urban HIV infected population. The American journal of the medical sciences. 2008;335(2):89-94.

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007;298(17):2038-47.

Grams ME, Juraschek SP, Selvin E, Foster MC, Inker LA, Eckfeldt JH, et al. Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2013;62(2):253-60.

Chapter 2: Definition, identification, and prediction of CKD progression. Kidney International Supplements. 2013;3(1):63-72.

Winocour PH. Diabetes and chronic kidney disease: an increasingly common multi-morbid disease in need of a paradigm shift in care. Diabetic medicine : a journal of the British Diabetic Association. 2017.

Medapalli R, Parikh CR, Gordon K, Brown ST, Butt AA, Gibert CL, et al. Comorbid diabetes and the risk of progressive chronic kidney disease in HIV-infected adults: Data from the Veterans Aging Cohort Study. Journal of acquired immune deficiency syndromes (1999). 2012;60(4):393-9.

Squires K, Pozniak AL, Pierone G, Jr., Steinhart CR, Berger D, Bellos NC, et al. Tenofovir disoproxil fumarate in nucleoside-resistant HIV-1 infection: a randomized trial. Annals of internal medicine. 2003;139(5 Pt 1):313-20.

Jones R, Stebbing J, Nelson M, Moyle G, Bower M, Mandalia S, et al. Renal dysfunction with tenofovir disoproxil fumarate-containing highly active antiretroviral therapy regimens is not observed more frequently: a cohort and case-control study. Journal of acquired immune deficiency syndromes (1999). 2004;37(4):1489-95.

Kooij KW, Vogt L, Wit F, van der Valk M, van Zoest RA, Goorhuis A, et al. Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls. The Journal of infectious diseases. 2017;216(6):622-31.

Social MdSyP. Guía para el Manejo del VIH/SIDA - Basada en la Evidencia - COLOMBIA. 2014.

Kalayjian RC, Lau B, Mechekano RN, Crane HM, Rodriguez B, Salata RA, et al. Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care. Aids. 2012; 26(15): 1907-15.


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