The impact of immunosuppression on chronic kidney disease in people living with HIV; the D:A:D study.

L Ryom, J D Lundgren, P Reiss, M Ross, O Kirk, C A Fux, P Morlat, E Fontas, C Smith, S De Wit, A d'Arminio Monforte, W El Sadr, C Hatleberg, A Phillips, C Sabin, M Law, A Mocroft

Journal of Infectious Diseases 2020 July 9

BACKGROUND: Relations between different measures of HIV-related immunosuppression and chronic kidney disease (CKD) remain unknown.

METHODS: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4<200, and CD4 recovery. CKD: confirmed estimated glomerular filtration rate <60mL/min/1.73m2.

RESULTS: Of 33,791 persons 2,226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4<200 (0 vs. >25%, IRR 0.77 [0.68-0.88]) with highest effect in those at low D:A:D CKD risk (0.45 [0.24-0.80]) vs. 0.80 [0.70-0.93]).

CONCLUSION: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.

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