Incidence and etiology of acute renal failure among ambulatory HIV-infected patients
Incidence and etiology of acute renal failure among ambulatory HIV-infected patients
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DOI：
10.1111/j.1523-1755.2005.00232.x
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发表时间：
2005-04-01
影响因子：
19.6
通讯作者：
Finn, WF
中科院分区：
文献类型：
--
作者：
Franceschini, N;Napravnik, S;Finn, WF
背景。急性肾衰竭（ARF）是人类免疫缺陷病毒（HIV）感染患者肾功能障碍的一个原因。自从在 HIV 流动患者中采用高效抗逆转录病毒治疗 (HAART) 以来，尚未对其发病率和原因进行研究。方法。这是一项前瞻性队列研究，纳入了 754 名 18 岁或以上的 HIV 患者，这些患者于 2000 年至 2002 年间在大学传染病诊所进行观察。ARF 是通过血清肌酐相对于基线的比例增加和图表审查来确定的。在 ARF 事件发生时评估临床状况。 ARF 发生率 (IR) 的计算方法是将事件数量除以处于危险中的人员时间。为了比较患有和不患有 ARF 的患者，使用了 t 检验或卡方检验。结果。患者的平均年龄为 40 岁； 68% 是男性，61% 是黑人。 71 名受试者发生了 111 起 ARF 事件（IR 5.9 每 100 人年；95% CI 4.9，7.1）。 ARF 在男性中更为常见，尤其是 CD4 细胞计数 < 200 个细胞/mm(3) 且 HIV RNA 水平 > 10,000 拷贝/mL 的男性。这些患者更常患有获得性免疫缺陷综合征（AIDS）、丙型肝炎感染（HCV），并接受过高效抗逆转录病毒疗法（HAART）。 ARF 主要是社区获得性的，由肾前性原因或急性肾小管坏死引起，并与机会性感染和药物有关。肝病是 HCV 感染患者 ARF 的一个原因。结论。 ARF 在流动 HIV 患者中很常见。免疫抑制、感染和HCV是后HAART时代与ARF相关的重要条件。
Background. Acute renal failure (ARF) is a cause of renal dysfunction in human immunodeficiency virus (HIV)-infected patients. Its incidence and causes have not been studied since the introduction of highly active antiretroviral therapy (HAART) in HIV ambulatory patients.Methods. This is a prospective cohort study of 754 HIV patients, 18 years or older, seen at a university-based infectious disease clinic between 2000 and 2002. ARF was identified using proportional increases in serum creatinine from baseline and by chart review. Clinical conditions were assessed at the time of the ARF event. ARF incidence rates (IR) were calculated by dividing the number of events by person time at risk. To compare patients with and without ARF, t test or chi-square test were used.Results. Patient's mean age was 40 years; 68% were male and 61% were black. One hundred-eleven ARF events occurred in 71 subjects (IR 5.9 per 100 person-years; 95% CI 4.9, 7.1). ARF was more common in men, in those with CD4 cell count < 200 cells/mm(3), and HIV RNA levels > 10,000 copies/mL. These patients more often had acquired immunodeficiency syndrome (AIDS), hepatitis C infection (HCV), and have received HAART. ARF was mainly community-acquired, due to prerenal causes or acute tubular necrosis, and associated with opportunistic infections and drugs. Liver disease was a cause of ARF in HCV-infected patients.Conclusion. ARF is common in ambulatory HIV patients. Immunosuppression, infection, and HCV are important conditions associated with ARF in the post-HAART era.