Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

<h4>Background</h4>Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nep...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Amanda Mocroft, Jens D Lundgren, Michael Ross, Matthew Law, Peter Reiss, Ole Kirk, Colette Smith, Deborah Wentworth, Jacqueline Neuhaus, Christoph A Fux, Olivier Moranne, Phillipe Morlat, Margaret A Johnson, Lene Ryom, D:A:D study group, Royal Free Hospital Clinic Cohort, INSIGHT study group, SMART study group, ESPRIT study group
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2015
Materias:
R
Acceso en línea:https://doaj.org/article/c2835c92bbb149ffb2fbec1962f07abc
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:c2835c92bbb149ffb2fbec1962f07abc
record_format dspace
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
spellingShingle Medicine
R
Amanda Mocroft
Jens D Lundgren
Michael Ross
Matthew Law
Peter Reiss
Ole Kirk
Colette Smith
Deborah Wentworth
Jacqueline Neuhaus
Christoph A Fux
Olivier Moranne
Phillipe Morlat
Margaret A Johnson
Lene Ryom
D:A:D study group
Royal Free Hospital Clinic Cohort
INSIGHT study group
SMART study group
ESPRIT study group
Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
description <h4>Background</h4>Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.<h4>Methods and findings</h4>A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria.<h4>Conclusions</h4>Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.
format article
author Amanda Mocroft
Jens D Lundgren
Michael Ross
Matthew Law
Peter Reiss
Ole Kirk
Colette Smith
Deborah Wentworth
Jacqueline Neuhaus
Christoph A Fux
Olivier Moranne
Phillipe Morlat
Margaret A Johnson
Lene Ryom
D:A:D study group
Royal Free Hospital Clinic Cohort
INSIGHT study group
SMART study group
ESPRIT study group
author_facet Amanda Mocroft
Jens D Lundgren
Michael Ross
Matthew Law
Peter Reiss
Ole Kirk
Colette Smith
Deborah Wentworth
Jacqueline Neuhaus
Christoph A Fux
Olivier Moranne
Phillipe Morlat
Margaret A Johnson
Lene Ryom
D:A:D study group
Royal Free Hospital Clinic Cohort
INSIGHT study group
SMART study group
ESPRIT study group
author_sort Amanda Mocroft
title Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
title_short Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
title_full Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
title_fullStr Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
title_full_unstemmed Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
title_sort development and validation of a risk score for chronic kidney disease in hiv infection using prospective cohort data from the d:a:d study.
publisher Public Library of Science (PLoS)
publishDate 2015
url https://doaj.org/article/c2835c92bbb149ffb2fbec1962f07abc
work_keys_str_mv AT amandamocroft developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT jensdlundgren developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT michaelross developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT matthewlaw developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT peterreiss developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT olekirk developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT colettesmith developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT deborahwentworth developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT jacquelineneuhaus developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT christophafux developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT oliviermoranne developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT phillipemorlat developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT margaretajohnson developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT leneryom developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT dadstudygroup developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT royalfreehospitalcliniccohort developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT insightstudygroup developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT smartstudygroup developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
AT espritstudygroup developmentandvalidationofariskscoreforchronickidneydiseaseinhivinfectionusingprospectivecohortdatafromthedadstudy
_version_ 1718375865974259712
spelling oai:doaj.org-article:c2835c92bbb149ffb2fbec1962f07abc2021-12-02T19:55:48ZDevelopment and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.1549-12771549-167610.1371/journal.pmed.1001809https://doaj.org/article/c2835c92bbb149ffb2fbec1962f07abc2015-03-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1001809https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.<h4>Methods and findings</h4>A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria.<h4>Conclusions</h4>Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Amanda MocroftJens D LundgrenMichael RossMatthew LawPeter ReissOle KirkColette SmithDeborah WentworthJacqueline NeuhausChristoph A FuxOlivier MorannePhillipe MorlatMargaret A JohnsonLene RyomD:A:D study groupRoyal Free Hospital Clinic CohortINSIGHT study groupSMART study groupESPRIT study groupPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 12, Iss 3, p e1001809 (2015)