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15th Annual Conference of the British HIV Association1-3 April 2009, Liverpool, UK |
CLINICAL EPIDEMIOLOGY OF END-STAGE RENAL FAILURE IN THE UK
HIV Med 2009 Apr 1-3 (Suppl 1);15:6 (abstract no. O5)
A Hughes1, L Bansi1, J Connolly2, S Edwards3, N Mackie4, M Fisher5, C Sabin2 and F Post6
1Chelsea and Westminster Hospital, London, UK, 2University College London, London, UK, 3Mortimer Market Centre, London, UK, 4St Mary’s Hospital, London, UK, 5Brighton and Sussex University Hospitals, Brighton, UK, 6King’s College London, London, UK
INTRODUCTION: In HIV-infected persons the US, there has been an ‘epidemic’ of end-stage renal failure (ESRF) requiring renal replacement therapy (RRT). It is unclear whether a similar increase in patients requiring RRT has occurred in the UK.
METHODS: Patients with HIV/ESRF from 1998–2007 were identified on the UK CHIC and local renal databases. The trend in ESRF case load was studied, and the clinical characteristics and survival compared for patients with HIV-associated nephropathy (HIVAN) and patients with ESRF due to other renal failure aetiologies.
RESULTS: Of the 70 patients with ESRF, 66% were black and 38 (54%) had HIVAN. The number of patients requiring RRT in each consecutive 2 year period increased from eight in 1998/1999 to 51 in 2006/2007. Patients with HIVAN/other renal failure aetiologies had similar degrees of immunodeficiency (nadir CD4 cell count and AIDS), while those with HIVAN had more advanced renal disease at HIV diagnosis (median eGFR 11 versus 50 mL/min, P=0.01), spent less time between HIV diagnosis and RRT initiation (137 versus 2171 days, P< 0.0001), and more often commenced RRT within 3 months of initiating HIV care (47% versus 16%, P=0.01). Of the patients with HIVAN/other renal failure aetiologies who commenced RRT while in HIV care for at least 3 months, a similar proportion had commenced HAART (74% versus 81%, P=0.57) prior to RRT, resulting in similar CD4 cell counts (266 versus 246, P=0.89) at RRT initiation. Five years after starting RRT, 75% of patients with HIVAN were alive compared with 59% of patients with other renal failure aetiologies (P=0.12).
CONCLUSIONS: The burden of ESRF increased more than six fold during the HAART era. Patients with HIVAN had more advanced renal failure at HIV presentation and a more fulminant course of kidney disease thereafter. Earlier HIV diagnosis in black patients will be an important strategy to stem the increase in number of patients with HIV/ESRF in the UK.
2009-04-01
O5
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