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. 2003 Jul 1:4:5.
doi: 10.1186/1471-2369-4-5.

HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

Kevin C Abbott  1 , Fernando C Trespalacios, Lawrence Y Agodoa, Tejinder S Ahuja
Affiliations

HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

Kevin C Abbott et al. BMC Nephrol. .

Abstract

Background: The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN), namely of angiotensin converting enzyme inhibitors (ACE) and antiretroviral therapy, has not been reported for a national sample of dialysis patients.

Methods: We conducted a historical cohort study of the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR) with HIVAN as a cause of end stage renal disease (ESRD) and its impact on mortality during the study period, adjusted for potential confounders.

Results: Of the 3374 patients who started dialysis, 36 (1.1%) had ESRD as a result of HIVAN. Only 22 (61%) of patients with HIVAN received antiretroviral agents, and only nine patients (25%) received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60), or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p < 0.01) compared to patients with other causes of ESRD.

Conclusions: Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.

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Figures

Figure 1
Figure 1
Survival, Dialysis Morbidity and Mortality Wave II Cohort (DMMS II), 1996 only, N = 3374, patients with Human Immunodeficiency Virus (HIV) associated nephropathy (HIVAN) vs. patients with other causes of end stage renal disease (ESRD), p < 0.01 by Log Rank Test.
Figure 2
Figure 2
Survival in HIVAN infected patients on chronic dialysis, 1996 DMMS II, by angiotensin converting enzyme inhibitor (ACE) use. P = 0.53 by Log Rank Test.
Figure 3
Figure 3
Survival in patients on chronic dialysis, 1996 DMMS II, by angiotensin converting enzyme inhibitor (ACE) use. P = 0.85 by Log Rank Test.
Figure 4
Figure 4
Survival, Dialysis Morbidity and Mortality Wave II Cohort (DMMS II), 1996 only, N = 3374, patients with Human Immunodeficiency Virus (HIV) associated nephropathy (HIVAN) who received combination retroviral therapy (COMBO) vs. all those who did not (NO COMBO), including those who were treated with single anti-retroviral agents, p = 0.77 by Log Rank Test.
See this image and copyright information in PMC

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