Clinical and Experimental Nephrology

, Volume 23, Issue 11, pp 1272–1279 | Cite as

Prevalence of chronic kidney disease among HIV-1-infected patients receiving a combination antiretroviral therapy

  • Leonardo CalzaEmail author
  • Michele Sachs
  • Vincenzo Colangeli
  • Marco Borderi
  • Bianca Granozzi
  • Pietro Malosso
  • Giorgia Comai
  • Valeria Corradetti
  • Gaetano La Manna
  • Pierluigi Viale
Original article



Chronic kidney disease (CKD) has become one of the most frequent non-infectious comorbidities in the aging HIV-infected population on long-standing combination antiretroviral therapy (cART).


We conducted a retrospective, cross-sectional study including HIV-infected adult patients attending our HIV outpatient clinic during the years 2017 and 2018 to assess prevalence and associated risk factors of CKD. Estimated glomerular filtration rate (eGFR) was measured by Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. CKD was diagnosed and classified according to the National Kidney Foundation guidelines. Logistic regression was employed to identify factors associated with CKD.


We enrolled 2339 HIV-infected patients (91% were Caucasian) with a mean age of 45.3 years and a mean current CD4 lymphocyte count of 531 cells/mm3. CKD was diagnosed in 311 subjects (13.3%). Overall, 294 (12.6%) patients had albuminuria, 108 (4.6%) had eGFR < 60 mL/min/1.73 m2, and 78 (3.3%) had albuminuria plus eGFR < 60 mL/min/1.73 m2. Stages 4–5 of CKD were documented in 23 (1%) cases. Age greater than 50 years, male gender, hypertension, diabetes mellitus, high triglycerides, nadir CD4 cell count < 200 cells/mm3, current use of tenofovir disoproxyl fumarate (TDF) and of TDF plus a ritonavir-boosted protease inhibitors were independently associated with CKD, while current use of abacavir plus one integrase inhibitor was associated with a reduced risk of CKD.


There is a significant prevalence of CKD among HIV-infected persons in association with both traditional and HIV-specific risk factors, requiring a careful periodic monitoring of renal function in these patients.


Renal dysfunction Glomerular filtration rate Proteinuria Albuminuria Antiretroviral drugs 


Compliance with ethical standards

Conflicts of interest

There are no conflicts of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at the S.Orsola-Malpighi Hospital approval (approval number: 198/2017/O/Oss).


  1. 1.
    Collaboration Antiretroviral Therapy Cohort. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4:e349–e356356.CrossRefGoogle Scholar
  2. 2.
    Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15:810–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ekrikpo U, Kengne A, Bello A, et al. Chronic kidney disease in the global adult HIV-infected population: a systematic review and meta-analysis. PLoS One. 2018;13:e0195443.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kooij KW, Vogt L, Wit FW, 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. J Infect Dis. 2017;216:622–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Rasmussen LD, May MT, Kronborg G, et al. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study. Lancet HIV. 2015;2:e288–e298298.CrossRefPubMedGoogle Scholar
  6. 6.
    Woodward CL, Hall AM, Williams IG, et al. Tenofovir-associated renal and bone toxicity. HIV Med. 2009;10:482–7.CrossRefGoogle Scholar
  7. 7.
    Hamzah L, Jose S, Booth JW, et al. Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate. J Infect. 2017;74:492–500.CrossRefPubMedGoogle Scholar
  8. 8.
    Mocroft A, Lundgren JD, Ross M, 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. Lancet HIV. 2016;3:e23–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Ryom L, Mocroft A, Kirk O, et al. Predictors of estimated glomerular filtration rate progression, stabilization or improvement after chronic renal impairment in HIV-positive individuals. AIDS. 2017;31:1261–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Ando M, Yanagisawa N. Epidemiology, clinical characteristics, and management of chronic kidney disease in human immunodeficiency virus-infected patients. World J Nephrol. 2015;4:388–95.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bruggeman LA, Bark C, Kalayjan RC. HIV and the kidney. Curr Infect Dis Rep. 2009;11:479–85.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367:20–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.Google Scholar
  14. 14.
    Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Disease Society of America. Clin Infect Dis. 2005;40:1559–855.CrossRefPubMedGoogle Scholar
  15. 15.
    Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease Work Group. KDIGO. clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;2013(3):1–150.Google Scholar
  16. 16.
    Lucas GM, Ross MJ, Stock PG, et al. Clinical practice guidelines 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. Clin Infect Dis. 2014;59:e96–138.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Halle MP, Oumarou M, Kaze Folefack F, Mapoure Y, Mbatchou Ngahane BH, Luma Namme H. Prevalence and associated factors of chronic kidney disease among patients infected with human immunodeficiency virus in Cameroon. Iran J Kidney Dis. 2018;12:268–74.Google Scholar
  18. 18.
    Yanagisawa N, Muramatsu T, Koibuchi T et al (2018) Prevalence of chronic kidney disease and poor diagnostic accuracy of dipstick proteinuria in human immunodeficiency virus-infected individuals: a multicenter study in Japan. Open Forum Infect Dis 5:ofy216Google Scholar
  19. 19.
    Juega-Marino J, Bonjoch A, Perez-Alvarez N, et al. Prevalence, evolution, and related risk factors of kidney disease among Spanish HIV-infected individuals. Medicine (Baltimore). 2017;96:e7421.CrossRefGoogle Scholar
  20. 20.
    Calza L, Vanino E, Magistrelli E, et al. Prevalence of renal disease within an urban HIV-infected cohort in Northern Italy. Clin Exp Nephrol. 2014;18:104–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Sutton SS, Magagnoli J, Cummings TH, Hardin JW, Edun B, Beaubrun A (2018) Chronic kidney disease, cardiovascular disease, and osteoporotic fractures in patients with and without HIV in the US Veteran’s Affairs Administration System. Curr Med Res Opin (Epub ahead of print) Google Scholar
  22. 22.
    Mocroft A, Kirk O, Reiss P, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS. 2010;24:1667–788.CrossRefPubMedGoogle Scholar
  23. 23.
    Arribas JR, Thompson M, Sax PE, et al. Brief report: randomized, double-blind comparison of tenofovir alafenamide (TAF) vs tenofovir disoproxil fumarate (TDF), each coformulated with elvitegravir, cobicistat, and emtricitabine (E/C/F) for initial treatment: week 144 results. J Acquir Immune Defic Syndr. 2017;75:211–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Raffi F, Orkin C, Clarke A, et al. Brief report: long-term (96-week) efficacy and safety after switching from tenofovir disoproxil fumarate to tenofovir alafenamide in HIV-infected, virologically suppressed adults. J Acquir Immune Defic Syndr. 2017;75:226–31.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Achhra AC, Nugent M, Mocroft A, Ryom L, Wyatt CM. Chronic kidney disease and antiretroviral therapy in HIV-positive individuals: recent developments. Curr HIV/AIDS Rep. 2016;13:149–57.CrossRefGoogle Scholar
  26. 26.
    Hamzah L, Jones R, Post FA. Optimizing antiretroviral regimens in chronic kidney disease. Curr Opin Infect Dis. 2019;32:1–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Maggi P, Montinaro V, Mussini C, et al. Novel antiretroviral drugs and renal function monitoring of HIV patients. AIDS Rev. 2014;16:144–51.PubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Leonardo Calza
    • 1
    Email author
  • Michele Sachs
    • 1
  • Vincenzo Colangeli
    • 1
  • Marco Borderi
    • 1
  • Bianca Granozzi
    • 1
  • Pietro Malosso
    • 1
  • Giorgia Comai
    • 2
  • Valeria Corradetti
    • 2
  • Gaetano La Manna
    • 2
  • Pierluigi Viale
    • 1
  1. 1.Unit of Infectious Diseases, Department of Medical and Surgical SciencesS. Orsola Hospital, “Alma Mater Studiorum” University of BolognaBolognaItaly
  2. 2.Unit of Nephrology, Department of Medical and Surgical SciencesS.Orsola Hospital, University of BolognaBolognaItaly

Personalised recommendations