The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study

Abstract Background Relations between different measures of human immunodeficiency virus–related immunosuppression and chronic kidney disease (CKD) remain unknown. Methods Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate 25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68–.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24–.80]) vs 0.80 [95% CI, .70–.93]). Conclusions Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more. While HIV-related immunosuppression duration and severity both predict chronic kidney disease (CKD), the duration association is strongest. CKD risk related to low CD4 count diminishes once immune function is restored, and most strongly affects persons with low estimated CKD risk.