Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals

Emily Woolnough, Jennifer Hoy, Allen Cheng, Rowan Walker, Anastasia Chrysostomou, Ian John Woolley, Freya Langham, Michael A. Moso, Achini Weeraratne, Janine Trevillyan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: The current study aimed to validate existing risk prediction scores and identify predictors of chronic kidney disease (CKD) in the setting of HIV. Design and methods: A retrospective cohort study of HIV-positive individuals (n=748) with baseline estimated glomerular filtration rate (eGFR) more than 60 ml/ min was conducted at the Alfred Hospital, Melbourne, Australia. Multivariable regression analysis was performed to determine factors associated with development of CKD, defined as two consecutive measurements of eGFR less than 60 ml/min. The performance of CKD risk scores proposed by the Data Collection on Adverse Events of Anti- HIV Drugs (D:A:D) Study Group and Scherzer and colleagues were estimated by the area under the receiver operator curve (AUROC). Results: CKD developed in 37 individuals (5.0%), at a median of 4.7 (interquartile range 2.2, 6.2) years. Older age [odds ratio (OR) 3.03, 95% confidence interval (CI): 1.20, 7.65, P=0.02] and lower baseline eGFR (OR 10.39, 95% CI: 4.73, 22.83, P<0.001) were associated with the development of CKD. Neither current, nor cumulative tenofovir disoproxil fumarate (TDF) use was associated with progression to CKD [current TDF hazard ratio (HR) 1.05, 95% CI: 0.54, 2.07, P=0.88; cumulative TDF HR 1.03, 95% CI: 0.86, 1.24, P=0.75]. The short D:A:D and Scherzer scores were well calibrated, with the short D:A:D score demonstrating superior discrimination (short D:A:D AUROC 0.85, Scherzer AUROC 0.78, P=0.02). Conclusion: Older individuals and those with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk, who may benefit from aggressive management of risk factors.

Original languageEnglish
Pages (from-to)1829-1835
Number of pages7
JournalAIDS
Volume32
Issue number13
DOIs
Publication statusPublished - 28 May 2018

Keywords

  • Ageing
  • Chronic kidney disease
  • Glomerular filtration rate
  • HIV
  • Risk prediction tools

Cite this

Woolnough, Emily ; Hoy, Jennifer ; Cheng, Allen ; Walker, Rowan ; Chrysostomou, Anastasia ; Woolley, Ian John ; Langham, Freya ; Moso, Michael A. ; Weeraratne, Achini ; Trevillyan, Janine. / Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals. In: AIDS. 2018 ; Vol. 32, No. 13. pp. 1829-1835.
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title = "Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals",
abstract = "Objective: The current study aimed to validate existing risk prediction scores and identify predictors of chronic kidney disease (CKD) in the setting of HIV. Design and methods: A retrospective cohort study of HIV-positive individuals (n=748) with baseline estimated glomerular filtration rate (eGFR) more than 60 ml/ min was conducted at the Alfred Hospital, Melbourne, Australia. Multivariable regression analysis was performed to determine factors associated with development of CKD, defined as two consecutive measurements of eGFR less than 60 ml/min. The performance of CKD risk scores proposed by the Data Collection on Adverse Events of Anti- HIV Drugs (D:A:D) Study Group and Scherzer and colleagues were estimated by the area under the receiver operator curve (AUROC). Results: CKD developed in 37 individuals (5.0{\%}), at a median of 4.7 (interquartile range 2.2, 6.2) years. Older age [odds ratio (OR) 3.03, 95{\%} confidence interval (CI): 1.20, 7.65, P=0.02] and lower baseline eGFR (OR 10.39, 95{\%} CI: 4.73, 22.83, P<0.001) were associated with the development of CKD. Neither current, nor cumulative tenofovir disoproxil fumarate (TDF) use was associated with progression to CKD [current TDF hazard ratio (HR) 1.05, 95{\%} CI: 0.54, 2.07, P=0.88; cumulative TDF HR 1.03, 95{\%} CI: 0.86, 1.24, P=0.75]. The short D:A:D and Scherzer scores were well calibrated, with the short D:A:D score demonstrating superior discrimination (short D:A:D AUROC 0.85, Scherzer AUROC 0.78, P=0.02). Conclusion: Older individuals and those with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk, who may benefit from aggressive management of risk factors.",
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Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals. / Woolnough, Emily; Hoy, Jennifer; Cheng, Allen; Walker, Rowan; Chrysostomou, Anastasia; Woolley, Ian John; Langham, Freya; Moso, Michael A.; Weeraratne, Achini; Trevillyan, Janine.

In: AIDS, Vol. 32, No. 13, 28.05.2018, p. 1829-1835.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals

AU - Woolnough, Emily

AU - Hoy, Jennifer

AU - Cheng, Allen

AU - Walker, Rowan

AU - Chrysostomou, Anastasia

AU - Woolley, Ian John

AU - Langham, Freya

AU - Moso, Michael A.

AU - Weeraratne, Achini

AU - Trevillyan, Janine

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N2 - Objective: The current study aimed to validate existing risk prediction scores and identify predictors of chronic kidney disease (CKD) in the setting of HIV. Design and methods: A retrospective cohort study of HIV-positive individuals (n=748) with baseline estimated glomerular filtration rate (eGFR) more than 60 ml/ min was conducted at the Alfred Hospital, Melbourne, Australia. Multivariable regression analysis was performed to determine factors associated with development of CKD, defined as two consecutive measurements of eGFR less than 60 ml/min. The performance of CKD risk scores proposed by the Data Collection on Adverse Events of Anti- HIV Drugs (D:A:D) Study Group and Scherzer and colleagues were estimated by the area under the receiver operator curve (AUROC). Results: CKD developed in 37 individuals (5.0%), at a median of 4.7 (interquartile range 2.2, 6.2) years. Older age [odds ratio (OR) 3.03, 95% confidence interval (CI): 1.20, 7.65, P=0.02] and lower baseline eGFR (OR 10.39, 95% CI: 4.73, 22.83, P<0.001) were associated with the development of CKD. Neither current, nor cumulative tenofovir disoproxil fumarate (TDF) use was associated with progression to CKD [current TDF hazard ratio (HR) 1.05, 95% CI: 0.54, 2.07, P=0.88; cumulative TDF HR 1.03, 95% CI: 0.86, 1.24, P=0.75]. The short D:A:D and Scherzer scores were well calibrated, with the short D:A:D score demonstrating superior discrimination (short D:A:D AUROC 0.85, Scherzer AUROC 0.78, P=0.02). Conclusion: Older individuals and those with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk, who may benefit from aggressive management of risk factors.

AB - Objective: The current study aimed to validate existing risk prediction scores and identify predictors of chronic kidney disease (CKD) in the setting of HIV. Design and methods: A retrospective cohort study of HIV-positive individuals (n=748) with baseline estimated glomerular filtration rate (eGFR) more than 60 ml/ min was conducted at the Alfred Hospital, Melbourne, Australia. Multivariable regression analysis was performed to determine factors associated with development of CKD, defined as two consecutive measurements of eGFR less than 60 ml/min. The performance of CKD risk scores proposed by the Data Collection on Adverse Events of Anti- HIV Drugs (D:A:D) Study Group and Scherzer and colleagues were estimated by the area under the receiver operator curve (AUROC). Results: CKD developed in 37 individuals (5.0%), at a median of 4.7 (interquartile range 2.2, 6.2) years. Older age [odds ratio (OR) 3.03, 95% confidence interval (CI): 1.20, 7.65, P=0.02] and lower baseline eGFR (OR 10.39, 95% CI: 4.73, 22.83, P<0.001) were associated with the development of CKD. Neither current, nor cumulative tenofovir disoproxil fumarate (TDF) use was associated with progression to CKD [current TDF hazard ratio (HR) 1.05, 95% CI: 0.54, 2.07, P=0.88; cumulative TDF HR 1.03, 95% CI: 0.86, 1.24, P=0.75]. The short D:A:D and Scherzer scores were well calibrated, with the short D:A:D score demonstrating superior discrimination (short D:A:D AUROC 0.85, Scherzer AUROC 0.78, P=0.02). Conclusion: Older individuals and those with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk, who may benefit from aggressive management of risk factors.

KW - Ageing

KW - Chronic kidney disease

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