Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy

Abstract

In the modern era, it is unknown if people that are virally suppressed with HIV (PWH) are at increased risk for acute kidney injury (AKI) compared to people without HIV and no studies have compared the risk of AKI by viral suppression status. Here, we determined the associations of HIV status and AKI among PWH with and without viral suppression compared to people without HIV. An observational cohort study of PWH and people without HIV hospitalized in a large New York City health system between 2010-2019 was conducted. Multivariable Cox proportional hazards models were used to determine associations between HIV status and risk of AKI, severe AKI and development of chronic kidney disease (CKD). Among 173,884 hospitalized patients, 4,718 had HIV; 2,532 (53.7%) were virally suppressed and 2,186 (46.3%) were not suppressed. Compared to people without HIV, PWH with and without viral suppression were at increased risk of AKI (adjusted hazard ratio 1.27, 95% confidence interval 1.15, 1.40 and 1.73, 1.58, 1.90, respectively) and AKI requiring kidney replacement therapy (1.89, 1.27, 2.84 and 1.87, 1.23, 2.84, respectively). Incremental, graded associations were observed between HIV status and Stage 2 or 3 AKI, and among AKI survivors, and incident CKD. The elevated risk of AKI across ages of PWH was similar in magnitude to older people without HIV. Thus, regardless of virologic control, HIV is an independent risk factor for AKI among hospitalized patients. Future studies should determine the mechanisms by which HIV increases susceptibility to AKI and identify strategies to prevent AKI in PWH.

Keywords: HIV; acute kidney injury; hospital; outcomes.

Figure 1 |. Flowchart of the study population.

AKI, acute kidney injury; ART, antiretroviral therapy; MMC, Montefiore Medical Center.

Figure 2 |. Independent factors associated with hospital acute kidney injury.

Data adjusted for age, sex, Black race, chronic kidney disease (CKD), diabetes, hypertension, hyperlipidemia, cardiovascular disease, hepatitis C infection, pulmonary disease, intensive care unit (ICU) admission, and prescription for angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, nonsteroidal anti-inflammatory drug, or tenofovir disoproxil fumarate. Adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) are as follows: HIV(+) suppressed, 1.27 (1.15–1.40); HIV(+) unsuppressed, 1.73 (1.58–1.90); female sex, 0.88 (0.86–0.90); diabetes, 1.26 (1.23–1.29); hypertension, 1.21 (1.17–1.25); cardiovascular disease, 1.11 (1.09–1.14); CKD, 1.60 (1.56–1.65); hepatitis C, 1.27 (1.20–1.34); and ICU admission, 1.58 (1.54–1.62).

Figure 3 |. Risk of hospital acute kidney injury by HIV status across age tertiles.

Data are adjusted for sex, Black race, chronic kidney disease, diabetes, hypertension, cardiovascular disease, hepatitis C infection, and intensive care unit admission. Adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) are as follows: HIV(–) for those aged <40 years, reference; HIV(–) for those aged 40 to 59 years, 1.27 (1.22–1.33); HIV(–) for those aged ≥60 years, 1.63 (1.57–1.70); HIV(+) for those aged <40 years, 1.82 (1.60–2.07); HIV(+) for those aged 40 to 59 years, 1.80 (1.65–1.97); and HIV(+) for those aged ≥60 years, 1.84 (1.58–2.15).