Predictors of eGFR progression, stabilisation or improvement after chronic renal impairment in HIV-positive individuals. AIDS
Ryom et al. on behalf of the D:A:D study group aimed to investigate the improvement in estimated glomerular filtration rate (eGFR) after development of chronic renal impairment (CRI) in HIV-positive individuals. The median of all eGFRs measured 24–36 months after CRI was compared with the median eGFR defining CRI, and changes were grouped into improvement (>+10 ml/min), stabilization (-10 to +10 ml/min) and progression (
Of 2006 individuals developing CRI, 21% subsequently improved eGFR, 67% stabilized and 12% progressed. Individuals remaining on tenofovir (TDF) or atazanavir boosted with ritonavir ATV/r 24 months post-CRI had worse eGFR outcomes compared with those unexposed (TDF: 0.47 and ATV/r: 0.63). Individuals off TDF for 12-24 months or off ATV/r for more than 12 months had similar eGFR outcomes as those unexposed to these antiretrovirals. Older age, hypertension, later date of CRI and diabetes were associated with worse eGFR outcomes.
In conclusion, the study-results suggest that eGFR improvement after CRI is relatively common, with one in five individuals experiencing significant eGFR improvement, and 23% experiencing complete resolution of CRI. Likewise, most HIV-positive individuals progressing to CRI subsequently stabilized eGFR at moderate levels of renal impairment rather than continued to decline. These observations offer reassurance for HIV-positive persons and their healthcare providers, as it seems that at least some of the excess renal risk among HIV-positive persons can be modified with appropriate management.