Prevalence of Chronic Kidney Disease Among HIV-infected Individuals in Japan: A Report From Two Tertiary Hospitals

Background : The improved survival of subjects with human immunodeficiency virus (HIV) has been accompanied by an increased prevalence of chronic kidney disease（CKD). Epidemic of CKD among those with HIV has not yet been evaluated in multiple tertiary hospitals in Japan. Methods: A cross-sectional study was conducted in 2011 at Tokyo Metropolitan Komagome Hospital (TMKH) and Tokyo Medical University Hospital (TMUH). A total of 1482 HIV-infected subjects (1384 men, 98 female, mean age : 44.2 ± 11.4 years old) were consecutively enrolled in the study. Random urine and blood samples were collected to study prevalence of CKD. CKD was diagnosed as a decrease in glomerular function and/or proteinuria and classified into 5 stages based on National Kidney Foundation guidelines. The estimated glomerular filtration rate based on serum creatinine was calculated using the 3-variable equation, constructed by the Japanese Society of Nephrology. Proteinuria was defined as ≧1＋on urine dipstick examination. All electronic medical charts were reviewed to determine comorbidities, including hypertension and diabetes mellitus (DM). The proportion of subjects receiving tenofovir disoproxil fumarate (TDF) was investigated. Risk factors for CKD were determined using multivariate logistic regression analysis. Results : The mean CD4 cell count was 487 ± 216/μL and 80.5％ had undetectable HIV-RNA level in the combined cohort. Of the 90.2％ of subjects taking antiretroviral agents, 61.5％ was using TDF. The prevalence of overall CKD and CKD ≧stage 3 was 12.9％ and 6.7％, respectively, both of which were nearly 3-fold higher in the TMKH cohort (p＜.0001). Mean age and proportional prevalent hypertension and DM were significantly higher in the TKMH cohort than in the TMUH cohort. Multivariate analysis showed significant CKD to be associated with age ≧50 years (odds ratio [OR], 2.81), hypertension (OR, 3.04), and DM (OR, 2.05). Conclusions : CKD prevalence was 12.9％ among combined cohorts, but differed significantly between them. Differences in age distribution and the proportion of comorbidities, including hypertension and DM, are likely involved.