Outcome and Prognostic Factors in HIV-1–Infected Patients on Dialysis in the cART Era: a GESIDA/SEN Cohort Study

Background:Prognosis of HIV-infected patients on dialysis has improved. Few studies have compared survival between HIV-infected and HIV-negative patients on dialysis in the combined antiretroviral therapy (cART) era. We compared the outcome of HIV-infected patients on dialysis with a matched HIV-negative cohort. Methods:National, multicenter, retrospective cohort study of HIV-infected patients starting dialysis in Spain (1999-2006). Matching criteria for HIV-negative patients were dialysis center, year of starting dialysis, age, sex, and race. Results:The study population comprised 122 patients, 66 HIV-infected, and 66 HIV-negative patients. Median age was 41 years, and all but 4 HIV-infected patients were white. HIV-associated nephropathy was only present in 4 cases. HIV-infected patients were less frequently included on the kidney transplantation waiting list (17% vs 62%, P < 0.001). They also had more hepatitis C virus coinfection (76% vs 11%, P < 0.001), fewer cardiovascular events (62% vs 88%, P = 0.001), fewer kidney transplants (4.5% vs 38%, P < 0.001), and higher mortality (32% vs 1.5%, P < 0.001). Survival rates [95% confidence interval (CI)] at 1, 3, and 5 years for HIV-infected patients were 95.2% (89.9%-100%), 71.7% (59.7%-83.7%), and 62.7% (46.6%-78.8%). Five-year survival for HIV-negative patients was 94.4% (83.8%-100%) (P < 0.001). Multivariate analysis revealed the following variables to be associated with death in HIV-infected patients: peritoneal dialysis vs hemodialysis [hazard ratio; (95% CI): 2.88 (1.16-7.17)] and being on effective cART [hazard ratio (95% CI): 0.39 (0.16-0.97)]. Conclusions:Medium-term survival of HIV-infected patients on dialysis was lower than that of matched HIV-negative patients. Fewer HIV-infected patients had access to kidney transplantation. Being on effective cART improves survival. Further studies are needed to determine whether peritoneal dialysis increases mortality.

[1]  J. Miro,et al.  Renal transplantation in HIV-infected patients: 2010 update. , 2011, Kidney International.

[2]  A. Mocroft,et al.  Dialysis and Renal Transplantation in HIV-Infected Patients: a European Survey , 2010, Journal of acquired immune deficiency syndromes.

[3]  D. Stablein,et al.  Outcomes of kidney transplantation in HIV-infected recipients. , 2010, The New England journal of medicine.

[4]  J. Axelsson,et al.  Daily peritoneal ultrafiltration predicts patient and technique survival in anuric peritoneal dialysis patients. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[5]  Jon J Snyder,et al.  Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. , 2010, Journal of the American Society of Nephrology : JASN.

[6]  C. Leen,et al.  Clinical epidemiology of HIV-associated end-stage renal failure in the UK , 2009, AIDS.

[7]  Tze-Wah Kao,et al.  Rate of decline of residual renal function is associated with all-cause mortality and technique failure in patients on long-term peritoneal dialysis. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[8]  J. Bromberg,et al.  Factors Associated with Failure to List HIV‐Positive Kidney Transplant Candidates , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[9]  J. Miro,et al.  Prevalence and clinical characteristics of HIV type 1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006: GESIDA 48/05 study. , 2008, AIDS research and human retroviruses.

[10]  Anne M Johnson,et al.  Changes in the risk of death after HIV seroconversion compared with mortality in the general population. , 2008, JAMA.

[11]  D. Fine,et al.  Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  M. Rivera,et al.  Quiz page. A peritoneal dialysis patient with HIV infection and abdominal pain: massive sclerosing encapsulating peritonitis. , 2007, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  P. Klotman,et al.  HIV-associated nephropathy in the era of antiretroviral therapy. , 2007, The American journal of medicine.

[14]  J. Bragg-Gresham,et al.  Outcome and prognosis factors in HIV-infected hemodialysis patients. , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[15]  M. Allon,et al.  Catheter-related bacteraemia in haemodialysis patients with HIV infection. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[16]  M. Pintilie.  Competing Risks: A Practical Perspective , 2006 .

[17]  J. Kooman,et al.  Peritoneal sclerosis--aetiology, diagnosis, treatment and prevention. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[18]  F. Goebel,et al.  HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  José A. Salvador,et al.  Documento de consenso GESIDA/GESITRA-SEIMC, SPNS y ONT sobre trasplante de órgano sólido en pacientes infectados por el VIH en España (marzo 2005) , 2005 .

[20]  James R. Johnson.  Pathogenesis and Treatment of HIV-Associated Renal Diseases: Lessons from Clinical and Animal Studies, Molecular Pathologic Correlations, and Genetic Investigations , 2003 .

[21]  J. Grady,et al.  Is dialysis modality a factor in survival of patients with ESRD and HIV-associated nephropathy? , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[22]  M. Mendelson,et al.  Determinants of survival among HIV-infected chronic dialysis patients. , 2003, Journal of the American Society of Nephrology : JASN.

[23]  A. Mocroft,et al.  Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study , 2002, AIDS.

[24]  J. Grady,et al.  Changing trends in the survival of dialysis patients with human immunodeficiency virus in the United States. , 2002, Journal of the American Society of Nephrology : JASN.

[25]  L. Agodoa,et al.  Human immunodeficiency virus/acquired immunodeficiency syndrome-associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival in the pre highly active antiretroviral therapy era. , 2001, Journal of nephrology.

[26]  G. von Gersdorff,et al.  Tunneled-cuffed catheter associated infections in hemodialysis patients who are seropositive for the human immunodeficiency virus. , 2000, Journal of the American Society of Nephrology : JASN.

[27]  J. Grady,et al.  Highly active antiretroviral therapy improves survival of HIV-infected hemodialysis patients. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[28]  G. Mazzucco,et al.  Pattern of glomerular involvement in human immunodeficiency virus-infected patients: an Italian study. , 1995, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[29]  P. Kimmel,et al.  Continuous ambulatory peritoneal dialysis and survival of HIV infected patients with end-stage renal disease. , 1993, Kidney international.

[30]  A. Kliger,et al.  Outcome of HIV infected patients on continuous ambulatory peritoneal dialysis. , 1993, Kidney international.

[31]  J. Bourgoignie,et al.  Outcome of patients with human immunodeficiency virus on maintenance hemodialysis. , 1988, Kidney international.

[32]  M. Dratwa,et al.  First Use of Tamoxifen in an HIV Patient with Encapsulating Peritoneal Sclerosis , 2007, Clinical drug investigation.

[33]  J. Ehrich,et al.  Combined report on regular dialysis and transplantation in Europe, XXI, 1990. , 1991, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[34]  G. Kootstra,et al.  A survey of vascular access for haemodialysis in The Netherlands. , 1991, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[35]  R. Romero,et al.  HIV infection and renal transplantation. , 1989, Nephron.

[36]  F. Brunner,et al.  Combined report on regular dialysis and transplantation of children in Europe, 1977. , 1978, Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association.