Screening for chronic kidney disease in HIV-infected patients

Abstract

With improved survival afforded by highly active antiretroviral therapy (HAART), CKD has emerged as one of the primary comorbid conditions affecting HIV-infected individuals. Although CKD in HIV-infected individuals is classically thought of as a consequence of advanced HIV infection such as in the case of HIV-associated nephropathy, several factors likely contribute to the development CKD in HIV infection. These factors include genetic predisposition, age-related decline in kidney function, HAART-related metabolic changes, exposure to multiple nephrotoxic medications, and concurrent conditions such as hepatitis C or illicit drug use. Similar to the general population, proteinuria and impaired kidney function are associated with faster progression to acquired immune deficiency syndrome and death. Given the prevalence and impact of kidney disease on the course of HIV infection and its management, current guidelines recommend screening all HIV-infected individuals for kidney disease. This review focuses on the current guidelines for kidney disease screening and discusses traditional as well as promising strategies for detecting CKD in this vulnerable population.

Figure 1. IDSA guidelines(26) for CKD screening in HIV infection with alternatives (italicized) based on the authors' opinions and the National Kidney Foundation guidelines(25)

Abbreviations: CKD, chronic kidney disease; GFR, glomerular filtration rate; MDRD, Modification of Diet in Renal Disease ^† CKD risk factors: African American, CD4⁺ cell count <200 cells/mm³, HIV-1 RNA >14,000 copies/ml, diabetes, hypertension, dyslipidemia, cocaine/cigarette use, hepatitis co-infection (Adapted with permission from AIDS Patient Care and STDs 21:813-824, 2007)