Clinical experience with chronic kidney disease in the HIV population: what have we learned?

Introduction : Chronic kidney disease (CKD) represents a significant global public health issue among people living with HIV (PLWH). The use of antiretroviral therapy (ART) is associated with increased prevalence of CKD and decreased glomerular filtration rate (GFR). Aim : This study set out to investigate the prevalence of CKD, and to describe trends in different stages of CKD in HIV-positive patients treated in Croatia. Participants and methods : In this retrospective cohort study, data from 1,143 HIV-positive patients of both sexes, aged over 18, treated at the University Hospital for Infectious Diseases in Zagreb, Croatia, were analyzed. CKD was defined using the MDRD equation to estimate GFR. Data were collected from medical records with the approval of the Hospital’s Ethics Committee. Statistical analysis was performed using the SAS program. Results : A total of 4,166 eGFR measurements were performed, of which 88.6% were from male patients. The most represented age group was 30–39 years (32.89%). AIDS-defining illness developed in 27.36%, ART was received in 91.77%, and viral suppression was achieved in 83.20% of participants. The most commonly used ART combination was ABC/3TC/EFV in 29.12% of participants. The distribution of CKD stages was as follows: Stage 1: 33.63%, Stage 2: 63.38%, Stage 3A: 3.60%, Stage 3B: 0.67%, Stage 4: 0.31%, and end Stage 5: 0.41%. Conclusion : Patients on ART more frequently show mild deviations in eGFR compared to those not on ART. Despite the small sample size, an increasing trend in CKD was observed. Regular monitoring of kidney function enables recognition of CKD in the early stages.