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Renal Impairment – Risk Factors

Risk Factors

Risk factors for renal impairment among non-HIV-infected people include:1,2

  • hypertension
  • diabetes
  • black race (African-American) and other genetic factors
  • family history
  • hepatitis B and/or C co-infection3,4 
  • age (>50yrs)
  • use of nephrotoxic drugs.

HIV-specific factors include:1,4–5 

  • lower CD4+ cell count (<200 cell/µL)
  • higher HIV viral load (>4,000 copies/mL)
    • HIV-associated nephropathy (HIVAN) may develop in the presence of the high viremia that can occur in advanced HIV disease or during acute HIV infection.6 
       


Risk factors for acute renal failure (ARF) in people living with HIV (PLWHIV) include:

  • older age
  • pre-existing chronic kidney disease (CKD)
  • serious systemic illness or infection
  • exposure to nephrotoxic agents.
     

For details of antivirals and antibiotics with known nephrotoxicity, find out more on screening for HIV-related renal disease.3



Independent risk factors for mortality include measures of renal function (elevated serum creatinine, proteinuria), and hypertension.4 In addition, some ARVs may increase hypertension, and thus the risk of renal dysfunction in PLWHIV.1 





References

  1. Fine DM. Renal disease and toxicities: issues for HIV care providers. Top HIV Med. 2007;14:164–169.  
  2. European AIDS Clinical Society (EACS). Guidelines. Version 6.0. Accessed 4 July 2012. 
  3. Aidsinfonet. HIV and kidney disease: What are the risk factors for kidney disease. Accessed 28 February 2011. 
  4. 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 Diseases Society of America. Clin Infect Dis. 2005;40:1559–1585.  
  5. Winston J, Deray G, Hawkins T, et al. Kidney disease in patients with HIV infection and AIDS. Clin Infect Dis. 2008;47:1449–1457. 
  6. Estrella MM, Fine DM, Atta MG. Recent developments in HIV-related kidney disease. HIV Ther. 2010;4:589–603.