Lipodystrophy increases the risk of CKD development in HIV-positive patients in Switzerland: The LIPOKID Study. Kidney International Reports
Bouatou et al. aimed to test the hypothesis that lipodystrophy syndrome (LD) is independently associated with the development of chronic kidney disease (CKD), as defined by an eGFR
Among the 5’384 patients included, 1’341 (24.9%) developed LD during the follow-up. The mean follow-up time was 72.3 months (SD ±48.4). In total, 252 patients (4.7%) reached the primary endpoint after a median time of 51.3 months (±SD 39.9 months) from inclusion. A diagnosis of LD significantly increased the risk of an eGFR on univariate analysis (hazard ratio [HR] = 2.72; 95% confidence interval [95% CI] = 2.07-3.58; P <0.001) and remained significantly higher after adjustment for known HIV and non-HIV risk factors for CKD (HR = 2.37; 95% CI = 1.67-3.36; P <0.001). The effect of LD on CKD was not mediated through the use of nephrotoxic antiretroviral drugs.
In conclusion, this is the first study demonstrating that clinically diagnosed LD is associated with CKD independently of known risk factors in a large prospective nationwide cohort study. These findings suggest that HIV-positive patients with LD should be monitored more closely with respect to renal function. In addition, exposure to nephrotoxic ARTs (e.g., Tenofovir Disoproxil Fumarat) should be minimized in these patients. Additional works exploring the pathophysiology of this clear association are needed.