Acute kidney injury among hospitalized people living with HIV

Objectives To describe the clinical characteristics, aetiologies, severity, and short-term outcomes of acute kidney injury (AKI) among hospitalized people living with HIV in a European tertiary HIV referral center. Methods This cross sectional analysis included adults living with HIV who developed AKI during hospitalization at Saint-Pierre University Hospital, Brussels, between 2007 and 2016. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Aetiologies, clinical characteristics, and outcomes were recorded, including intensive care unit admission, renal replacement therapy, renal recovery, chronic kidney disease (CKD) progression, in-hospital mortality, and one-year rehospitalization. Results Among 206 patients with AKI, 64% had KDIGO stage 1, 21% stage 2, and 15% stage 3 AKI. Pre-renal AKI was the most frequent aetiology (45%), followed by intrinsic (25%) and mixed AKI (16%). Intensive care unit admission occurred in 36% of patients and renal repolacement therapy was required in 12%. In-hospital mortality was 16%. Among survivors, 77% achieved renal recovery, 5% progressed to chronic kidney disease, and 38% were rehospitalized within 1 year. Conclusions AKI remains a clinically important complication among hospitalized people living with HIV, with substantial short-term morbidity and mortality. Early recognition and management of reversible causes and avoidance of nephrotoxic exposures remain important.