DOI 10.5414/CNP73190

Clinical Nephrology, Volume 73 (2010) - March (190 - 196)

Screening for chronic kidney disease in the ambulatory HIV population

T. Fulop1, J. Olivier2, R.S. Meador1, J. Hall3, N. Islam4, L. Mena5, H. Henderson5, D.W. Schmidt1
1 Division of Nephrology, Department of Internal Medicine, University of Mississippi Health Care, Jackson, MS, USA, 2 NSW Injury Risk Management Research Center & School of Mathematics, Statistics, University of New South Wales, Sydney, Australia, 3 Southwest Mississippi Nephrology Group, Brookhaven, MS, 4 Department of Family Medicine, University of Mississippi Health Care, 5 Division of Infectious Disease, Department of Internal Medicine, University of Mississippi Health Care, Jackson, MS, USA

Abstract

Background: In 2005, the Infectious Disease Society of America published a guideline recommending that all patients with human immunodeficiency virus (HIV) be screened for kidney disease. We initiated a screening program for kidney disease in a dedicated HIV clinic that follows 1,631 patients. Methods: The screening consisted of a serum creatinine, an estimated glomerular filtration rate (eGFR) as defined by the abbreviated Modification of Diet in Renal Disease equation, and a standard urinalysis for proteinuria. Subjects were identified as having a positive screen if they had 1+ proteinuria or greater on a standard urinalysis or an eGFR of less than 60 ml/min/ 1.73 m2. After 1 year of screening, a retrospective chart review was conducted to determine the efficacy of screening. Bivariate associations were assessed for each outcome. A multiple logistic regression analysis was conducted first with main effects models and then for all variables and interactions. Results: 941 subjects that did not have previously documented chronic kidney disease were screened and 96 (10.2%) met the definition of CKD. 9% of subjects had proteinuria and 2.4% had a qualifying eGFR. In multivariate analysis diabetes, hypertension, and low CD4 count (< 200 cells per mm3), low viral load (< 400 copies/ml) displayed strong associations with proteinuria. In the case of reduced eGFR, diabetes and age retained strong associations while the association with hypertension had borderline significance. Conclusion: This study emphasizes the potential of similar screening programs to identify early or mild CKD in an ambulatory population of patients with HIV.

Author Details

Authors

  • T. Fulop1
  • J. Olivier2
  • R.S. Meador1
  • J. Hall3
  • N. Islam4
  • L. Mena5
  • H. Henderson5
  • D.W. Schmidt1

Departments

  • 1 Division of Nephrology, Department of Internal Medicine, University of Mississippi Health Care, Jackson, MS, USA,
  • 2 NSW Injury Risk Management Research Center & School of Mathematics, Statistics, University of New South Wales, Sydney, Australia,
  • 3 Southwest Mississippi Nephrology Group, Brookhaven, MS,
  • 4 Department of Family Medicine, University of Mississippi Health Care,
  • 5 Division of Infectious Disease, Department of Internal Medicine, University of Mississippi Health Care, Jackson, MS, USA

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