BACKGROUND:
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.
METHODS AND FINDINGS:
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.
CONCLUSIONS:
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.
Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study
Mocroft, Amanda; Lundgren, Jens D.; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Deborah; Neuhaus, Jacqueline; Fux, Christoph A.; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret A.; Ryom, Lene; Lundgren J; Powderly B; Shortman N; Moecklinghoff C; Reilly G; Franquet X; Sabin C; Phillips A; Kirk O; Reiss P; Weber R; Pradier C; Law M; d'Arminio Monforte A; Dabis F; El Sadr W; De Wit S; Powderly B; Shortman N; Moecklinghoff C; Reilly G; Franquet X; Ryom L; Sabin C; Kamara D; Smith C; Phillips A; Mocroft A; Tverland J; Mansfeld M; Nielsen J; Raben D; Lundgren J; Salbøl Brandt R; Rickenbach M; Fanti I; Krum E; Hillebregt M; Geffard S; Sundström A; Delforge M; Fontas E; Torres F; McManus H; Wright S; Kjær J; Sjøl A; Meidahl P; Helweg Larsen J; Schmidt Iversen J; Ryom L; Mocroft A; Kirk O; Reiss P; Ross M; Fux C; Morlat P; Moranne O; Kesselring A; Kamara D; Smith C; Lundgren J; Smith C; Ryom L; Phillips A; Weber R; Morlat P; Pradier C; Reiss P; Friis Møller N; Kowalska J; Lundgren J; Sabin C; Law M; d'Arminio Monforte A; Dabis F; Bruyand M; Reiss P; Smith C; Kamara D; Bower M; Fätkenheuer G; Donald A; Grulich A; Ryom L; Lundgren J; Prins J; Kuijpers T; Scherpbier H; van der Meer J; Wit F; Godfried M; Reiss P; van der Poll T; Nellen F; Geerlings S; van Vugt M; Pajkrt D; Bos J; Wiersinga W; van der Valk M; Goorhuis A; Hovius J; van Eden J; Henderiks A; van Hes A; Mutschelknauss M; Nobel H; Pijnappel F; Westerman A; Jurriaans S; Back N; Zaaijer H; Berkhout B; Cornelissen M; Schinkel C; Thomas X; De Ruyter Ziekenhuis A; van den Berge M; Stegeman A; Baas S; Hage de Looff L; Versteeg D; Pronk M; Ammerlaan H; Korsten Vorstermans E; de Munnik E; Jansz A; Tjhie J; Wegdam M; Deiman B; Scharnhorst V; van der Plas A; Weijsenfeld A; van der Ende M; de Vries Sluijs T; van Gorp E; Schurink C; Nouwen J; Verbon A; Rijnders B; Bax H; Hassing R; van der Feltz M; Bassant N; van Beek J; Vriesde M; van Zonneveld L; de Oude Lubbers A; van den Berg Cameron H; Bruinsma Broekman F; de Groot J; de Zeeuw de Man M; Broekhoven Kruijne M; Schutten M; Osterhaus A; Boucher C; Driessen G; van Rossum A; van der Knaap L; Visser E; Branger J; Duijf van de Ven CJ; Schippers EF; van Nieuwkoop C; Brimicombe R; van IJperen JM; van der Hut G; Franck P; van Eeden A; Brokking W; Groot M; Damen M; Kwa I; Groeneveld P; Bouwhuis J; van den Berg J; van Hulzen A; van der Bliek G; Bor P; Bloembergen P; Wolfhagen M; Ruijs G; Gasthuis K; van Lelyveld S; Soetekouw R; Hulshoff N; van der Prijt L; Schoemaker M; Bermon N; van der Reijden W; Jansen R; Herpers B; Veenendaal D; Kroon FP; Arend S; de Boer M; Bauer M; Jolink H; Vollaard A; Dorama W; Moons C; Claas EC; Kroes A; den Hollander J; Pogany K; Kastelijns M; Smit J; Smit E; Bezemer M; van Niekerk T; Pontesilli O; Lowe S; Oude Lashof A; Posthouwer D; Ackens R; Schippers J; Vergoossen R; Weijenberg Maes B; Savelkoul P; Loo I; Weijer S; El Moussaoui R; Heitmuller M; Heitmuller M; Kortmann W; van Twillert G; Cohen Stuart J; Diederen B; Pronk D; van Truijen Oud F; van der Reijden W; Jansen R; Leyten E; Gelinck L; van Hartingsveld A; Meerkerk C; Wildenbeest G; Mutsaers J; Jansen C; van Vonderen M; van Houte D; Dijkstra K; Faber S; Weel J; Kootstra G; Delsing C; van der Burg van de Plas M; Heins H; Lucas E; Brinkman K; Frissen P; Blok W; Schouten W; Bosma A; Brouwer C; Geerders G; Hoeksema K; Kleene M; van der Meché I; Toonen A; Wijnands S; van Ogtrop M; Jansen R; Koopmans P; Keuter M; van der Ven AJ; ter Hofstede H; Dofferhoff A; van Crevel R; Albers M; Bosch M; Grintjes Huisman K; Zomer B; Stelma F; Burger D; Richter C; van der Berg J; Gisolf E; ter Beest G; van Bentum P; Langebeek N; Tiemessen R; Swanink C; Veenstra J; Lettinga K; Spelbrink M; Sulman H; Spelbrink M; Witte E; Damen M; Peerbooms P; Mulder J; Vrouenraets S; Lauw F; van Broekhuizen M; Paap H; Vlasblom D; Oudmaijer Sanders E; Smits P; Rosingh A; Verhagen D; Geilings J; van Kasteren M; Brouwer A; de Kruijf van de Wiel BA; Kuipers M; Santegoets R; van der Ven B; Marcelis J; Buiting A; Kabel P; Bierman W; Sprenger H; Scholvinck E; van Assen S; Wilting K; Stienstra Y; de Groot de Jonge H; van der Meulen P; de Weerd D; Niesters H; Riezebos Brilman A; van Leer Buter C; Hoepelman A; Schneider M; Mudrikova T; Ellerbroek P; Oosterheert J; Arends J; Barth R; Wassenberg M; van Elst Laurijssen D; Laan L; van Oers Hazelzet E; Patist J; Vervoort S; Nieuwenhuis H; Frauenfelder R; Schuurman R; Verduyn Lunel F; Wensing A; Peters E; van Agtmael M; Perenboom R; Bomers M; de Vocht J; Elsenburg L; Pettersson A; Vandenbroucke Grauls C; Ang C; Geelen S; Wolfs T; Bont L; Nauta N; Reiss P; Bezemer D; Gras L; van Sighem A; Smit C; Zaheri S; Hillebregt M; Kimmel V; Tong Y; Lascaris B; van den Boogaard R; Hoekstra P; de Lang A; Berkhout M; Grivell S; Jansen A; de Groot L; van den Akker M; Bergsma D; Lodewijk C; Meijering R; Peeck B; Raethke M; Ree C; Regtop R; Ruijs Y; Schoorl M; Tuijn E; Veenenberg L; Woudstra T; Bakker Y; de Jong A; Broekhoven M; Claessen E; Rademaker M; Munjishvili L; Kruijne E; Tuk B; Dabis F; Bonnet F; Dabis F; Dupon M; Chêne G; Breilh D; Fleury H; Malvy D; Mercié P; Pellegrin I; Morlat P; Neau D; Pellegrin J; Bouchet S; Gaborieau V; Lacoste D; Tchamgoué S; Thiébaut R; Chêne G; Dabis F; Thiébaut R; Bruyand M; Lawson Ayayi S; Wittkop L; Morlat P; Bonnet F; Bernard N; Hessamfar M; Lacoste D; Vandenhende M; Dupon M; Dauchy F; Dutronc H; Longy Boursier M; Mercié P; Duffau P; Schmeltz J; Malvy D; Pistone T; Receveur M; Neau D; Cazanave C; Ochoa A; Vareil MO; Pellegrin J; Viallard JF; Greib C; Lazaro E; Fleury H; Lafon M; Reigadas S; Trimoulet P; Breilh D; Molimard M; Bouchet S; Titier K; Moreau J; Pellegrin I; Haramburu F; Miremont Salamé G; Dupont A; Gerard Y; André K; Bonnal F; Farbos S; Gemain M; Ceccaldi J; Tchamgoué S; De Witte S; Courtault C; Monlun E; Gaborieau V; Lataste P; Meraud JP; Chossat I; Blaizeau M; Bruyand M; Conte V; Decoin M; Delaune J; Delveaux S; Diarra F; D'Ivernois C; Frosch A; Geffard S; Hannapier C; Lawson Ayayi S; Lenaud E; Leleux O; Le Marec F; Leray J; Louis I; Palmer G; Pougetoux A; Sicard X; Uwamaliya Nziyumvira D; Law M; Petoumenos K; McManus H; Wright S; Bendall C; Moore R; Edwards S; Hoy J; Watson K; Roth N; Nicholson J; Bloch M; Franic T; Baker D; Vale R; Carr A; Cooper D; Chuah J; Ngieng M; Nolan D; Skett J; Calvo G; Torres F; Mateu S; Domingo P; Sambeat M; Gatell J; Del Cacho E; Cadafalch J; Fuster M; Codina C; Sirera G; Vaqué A; De Wit S; Clumeck N; Delforge M; Necsoi C; Clumeck N; De Wit S; Gennotte A; Gerard M; Kabeya K; Konopnicki D; Libois A; Martin C; Payen M; Semaille P; Van Laethem Y; Neaton J; Bartsch G; El Sadr W; Krum E; Thompson G; Wentworth D; Luskin Hawk R; Telzak E; El Sadr W; Abrams D; Cohn D; Markowitz N; Arduino R; Mushatt D; Friedland G; Perez G; Tedaldi E; Fisher E; Gordin F; Crane L; Sampson J; Baxter J; Lundgren J; Kirk O; Mocroft A; Cozzi Lepri A; Grint D; Podlekareva D; Kjær J; Peters L; Reekie J; Kowalska J; Tverland J; Fischer A; Nielsen J; Losso M; Elias C; Vetter N; Zangerle R; Karpov I; Vassilenko A; Mitsura V; Suetnov O; Clumeck N; De Wit S; Delforge M; Colebunders R; Vandekerckhove L; Hadziosmanovic V; Kostov K; Begovac J; Machala L; Jilich D; Sedlacek D; Nielsen J; Kronborg G; Benfield T; Larsen M; Gerstoft J; Katzenstein T; Hansen E; Skinhøj P; Pedersen C; Ostergaard L; Zilmer K; Smidt J; Ristola M; Katlama C; Viard JP; Girard PM; Livrozet JM; Vanhems P; Pradier C; Dabis F; Neau D; Rockstroh J; Schmidt R; van Lunzen J; Degen O; Stellbrink H; Staszewski S; Bickel M; Fätkenheuer G; Kosmidis J; Gargalianos P; Xylomenos G; Perdios J; Panos G; Filandras A; Karabatsaki E; Sambatakou H; Banhegyi D; Mulcahy F; Yust I; Turner D; Burke M; Pollack S; Hassoun G; Maayan S; Vella S; Esposito R; Mazeu I; Mussini C; Arici C; Pristera R; Mazzotta F; Gabbuti A; Vullo V; Lichtner M; Chirianni A; Montesarchio E; Gargiulo M; Antonucci G; Testa A; Narciso P; Vlassi C; Zaccarelli M; Lazzarin A; Castagna A; Gianotti N; Galli M; Ridolfo A; d'Arminio Monforte A; Rozentale B; Zeltina I; Chaplinskas S; Hemmer R; Staub T; Reiss P; Ormaasen V; Maeland A; Bruun J; Knysz B; Gasiorowski J; Horban A; Bakowska E; Grzeszczuk A; Flisiak R; Boron Kaczmarska A; Pynka M; Parczewski M; Beniowski M; Mularska E; Trocha H; Jablonowska E; Malolepsza E; Wojcik K; Antunes F; Doroana M; Caldeira L; Mansinho K; Maltez F; Duiculescu D; Rakhmanova A; Zakharova N; Petersburg S; Buzunova S; Jevtovic D; Mokráš M; Staneková D; Tomazic J; González Lahoz J; Soriano V; Labarga P; Medrano J; Moreno S; Rodriguez J; Clotet B; Jou A; Paredes R; Tural C; Puig J; Bravo I; Gatell J; Miró J; Domingo P; Gutierrez M; Mateo G; Sambeat M; Karlsson A; Flamholc L; Ledergerber B; Weber R; Francioli P; Cavassini M; Hirschel B; Boffi E; Furrer H; Battegay M; Elzi L; Kravchenko E; Chentsova N; Frolov V; Kutsyna G; Servitskiy S; Krasnov M; Barton S; Johnson A; Mercey D; Phillips A; Johnson M; Mocroft A; Murphy M; Weber J; Scullard G; Fisher M; Leen C; Morfeldt L; Thulin G; Sundström A; Åkerlund B; Koppel K; Karlsson A; Flamholc L; Håkangård C; Moroni M; Angarano G; Antinori A; Armignacco O; d'Arminio Monforte A; Castelli F; Cauda R; Di Perri G; Galli M; Iardino R; Ippolito G; Lazzarin A; Perno C; von Schloesser F; Viale P; d'Arminio Monforte A; Antinori A; Castagna A; Ceccherini Silberstein F; Cozzi Lepri A; Girardi E; Lo Caputo S; Mussini C; Puoti M; Andreoni M; Ammassari A; Antinori A; d'Arminio Monforte A; Balotta C; Bonfanti P; Bonora S; Borderi M; Capobianchi R; Castagna A; Ceccherini Silberstein F; Cingolani A; Cinque P; Cozzi Lepri A; De Luca A; Di Biagio A; Girardi E; Gianotti N; Gori A; Guaraldi G; Lapadula G; Lichtner M; Lo Caputo S; Madeddu G; Maggiolo F; Marchetti G; Marcotullio S; Monno L; Mussini C; Puoti M; Quiros Roldan E; Rusconi S; Cozzi Lepri A; Cicconi P; Fanti I; Formenti T; Galli L; Lorenzini P; Giacometti A; Costantini A; Angarano G; Monno L; Santoro C; Maggiolo F; Suardi C; Viale P; Vanino E; Verucchi G; Castelli F; Quiros Roldan E; Minardi C; Quirino T; Abeli C; Manconi P; Piano P; VECCHIET, Jacopo ;FALASCA, KATIA ;Sighinolfi L; Segala D; Mazzotta F; Lo Caputo S; Cassola G; Viscoli G; Alessandrini A; Piscopo R; Mazzarello G; Mastroianni C; Belvisi V; Bonfanti P; Caramma I; Castelli A; Galli M; Lazzarin A; Rizzardini G; Puoti M; d'Arminio Monforte A; Ridolfo A; Piolini R; Castagna A; Salpietro S; Carenzi L; Moioli M; Cicconi P; Marchetti G; Mussini C; Puzzolante C; Gori A; Lapadula G; Abrescia N; Chirianni A; Guida M; Onofrio M; Baldelli F; Francisci D; Parruti G; Ursini T; Magnani G; Ursitti M; Cauda R; Andreoni M; Antinori A; Vullo V; Cingolani A; d'Avino A; Ammassari A; Gallo L; Nicastri E; Acinapura R; Capozzi M; Libertone R; Tebano G; Cattelan A; Mura M; Madeddu G; Caramello P; Di Perri G; Orofino G; Bonora S; Sciandra M; Pellizzer G; Manfrin V; Pradier C; Fontas E; Dollet K; Caissotti C; Dellamonica P; Roger P; Bernard E; Cua E; De Salvador Guillouet F; Durant J; Ferrando S; Dunais B; Mondain Miton V; Perbost I; Prouvost Keller B; Pugliese P; Naqvi A; Pillet S; Risso K; Aubert V; Barth J; Battegay M; Bernasconi E; Böni J; Bucher H; Burton Jeangros C; Calmy A; Cavassini M; Egger M; Elzi L; Fehr J; Fellay J; Furrer H; Fux C; Gorgievski M; Günthard H; Haerry D; Hasse B; Hirsch H; Hösli I; Kahlert C; Kaiser L; Keiser O; Klimkait T; Kovari H; Ledergerber B; Martinetti G; Martinez de Tejada B; Metzner K; Müller N; Nadal D; Pantaleo G; Rauch A; Regenass A; Rickenbach M; Rudin C; Schmid P; Schultze D; Schöni Affolter F; Schüpbach J; Speck R; Taffé P; Tarr P; Telenti A; Trkola A; Vernazza P; Weber R; Yerly S; Bhagani S; Burns F; Byrne P; Carroll A; Cropley I; Cuthbertson Z; Drinkwater T; Edwards S; Fernandez T; Garusu E; Gonzales A; Grover D; Hutchinson S; Killingley B; Murphy G; Ivens D; Johnson M; Kinloch de Loes S; Lipman M; Madge S; Marshall N; Montgomery H; Shah R; Swaden L; Tyrer M; Youle M; Webster D; Wright A; Chaloner C; Miah M; Tsintas R; Burch L; Cambiano V; Lampe F; Nakagawa F; O'Connor J; Phillips A; Smith C; Speakman A; Connell M; Clewley G; Martin S; Thomas M; Aagaard B; Aragon E; Arnaiz J; Borup L; Clotet B; Dragsted U; Fau A; Gey D; Grarup J; Hengge U; Herrero P; Jansson P; Jensen B; Jensen K; Juncher H; Lopez P; Lundgren J; Matthews C; Mollerup D; Pearson M; Phillips A; Reilev S; Tillmann K; Varea S; Angus B; Babiker A; Cordwell B; Darbyshire J; Dodds W; Fleck S; Horton J; Hudson F; Moraes Y; Pacciarini F; Palfreeman A; Paton N; Smith N; van Hooff F; Bebchuk J; Collins G; Denning E; DuChene A; Fosdick L; Harrison M; Herman Lamin K; Krum E; Larson G; Neaton J; Nelson R; Quan K; Quan S; Schultz T; Thompson G; Wentworth D; Wyman N; Carey C; Chan F; Cooper D; Cordwell B; Courtney Rodgers D; Drummond F; Emery S; Harrod M; Jacoby S; Kearney L; Law M; Lin E; Pett S; Robson R; Seneviratne N; Stewart M; Watts E; Finley E; Gordin F; Sánchez A; Standridge B; Vjecha M; Belloso W; Davey R; Duprez D; Gatell J; Hoy J; Lifson A; Pederson C; Perez G; Price R; Prineas R; Rhame F; Sampson J; Worley J; Modlin J; Beral V; Chaisson R; Fleming T; Hill C; Kim K; Murray B; Pick B; Seligmann M; Weller I; Cahill K; Fox L; Luzar M; Martinez A; McNay L; Pierson J; Tierney J; Vogel S; Costas V; Eckstrand J; Brown S; Abusamra L; Angel E; Aquilia S; Belloso W; Benetucci J; Bittar V; Bogdanowicz E; Cahn P; Casiro A; Contarelli J; Corral J; Daciuk L; David D; Dobrzanski W; Duran A; Ebenrstejin J; Ferrari I; Fridman D; Galache V; Guaragna G; Ivalo S; Krolewiecki A; Lanusse I; Laplume H; Lasala M; Lattes R; Lazovski J; Lopardo G; Losso M; Lourtau L; Lupo S; Maranzana A; Marson C; Massera L; Moscatello G; Olivia S; Otegui I; Palacios L; Parlante A; Salomon H; Sanchez M; Somenzini C; Suarez C; Tocci M; Toibaro J; Zala C; Agrawal S; Ambrose P; Anderson C; Anderson J; Baker D; Beileiter K; Blavius K; Bloch M; Boyle M; Bradford D; Britton P; Brown P; Busic T; Cain A; Carrall L; Carson S; Chenoweth I; Chuah J; Clark F; Clemons J; Clezy K; Cooper D; Cortissos P; Cunningham N; Curry M; Daly L; D'Arcy Evans C; Del Rosario R; Dinning S; Dobson P; Donohue W; Doong N; Downs C; Edwards E; Edwards S; Egan C; Ferguson W; Finlayson R; Forsdyke C; Foy L; Franic T; Frater A; French M; Gleeson D; Gold J; Habel P; Haig K; Hardy S; Holland R; Hoy J; Hudson J; Hutchison R; Hyland N; James R; Johnston C; Kelly M; King M; Kunkel K; Lau H; Leamy J; Lester D; Leung J; Lohmeyer A; Lowe K; MacRae K; Magness C; Martinez O; Maruszak H; Medland N; Miller S; Murray J; Negus P; Newman R; Ngieng M; Nowlan C; Oddy J; Orford N; Orth D; Patching J; Plummer M; Price S; Primrose R; Prone I; Ree H; Remington C; Richardson R; Robinson S; Rogers G; Roney J; Roth N; Russell D; Ryan S; Sarangapany J; Schmidt T; Schneider K; Shields C; Silberberg C; Shaw D; Skett J; Smith D; Meng Soo T; Sowden D; Street A; Kiem Tee B; Thomson J; Topaz S; Vale R; Villella C; Walker A; Watson A; Wendt N; Williams L; Youds D; Aichelburg A; Cichon P; Gemeinhart B; Rieger A; Schmied B; Touzeau Romer V; Vetter N; Colebunders R; Clumeck N; DeRoo A; Kabeya K; O'Doherty E; de Wit S; De Salles Amorim C; Basso C; Flint S; Kallas E; Levi G; Lewi D; Pereira L. Jr; da Silva M; Souza T; Toscano A; Angel J; Arsenault M; Bast M; Beckthold B; Bouchard P; Chabot I; Clarke R; Cohen J; Coté P; Ellis M; Gagne C; Gill J; Houde M; Johnston B; Jubinville N; Kato C; Lamoureux N; Larson G; Latendre Paquette J; Lindemulder A; McNeil A; McFarland N; Montaner J; Morrisseau C; O'Neill R; Page G; Piche A; Pongracz B; Preziosi H; Puri L; Rachlis A; Ralph E; Raymond I; Rouleau D; Routy J; Sandre R; Seddon T; Shafran S; Sikora C; Smaill F; Stromberg D; Trottier S; Walmsley S; Weiss K; Williams K; Zarowny D; Baadegaard B; Bengaard Andersen Á; Boedker K; Collins P; Gerstoft J; Jensen L; Moller H; Lehm Andersen P; Loftheim I; Mathiesen L; Nielsen H; Obel N; Pedersen C; Petersen D; Pors Jensen L; Trunk Black F; Aboulker J; Aouba A; Bensalem M; Berthe H; Blanc C; Bloch M; Bornarel D; Bouchaud O; Boue F; Bouvet E; Brancon C; Breaud S; Brosseau D; Brunet A; Capitant C; Ceppi C; Chakvetadze C; Cheneau C; Chennebault J; De Truchis P; Delavalle A; Delfraissy J; Dellamonica P; Delavalle A; Dumont C; Edeb N; Fabre G; Ferrando S; Foltzer A; Foubert V; Gastaut J; Gerbe J; Girard P; Goujard C; Hoen B; Honore P; Hue H; Hynh T; Jung C; Kahi S; Katlama C; Lang J; Le Baut V; Lefebvre B; Leturque N; Lévy Y; Loison J; Maddi G; Maignan A; Majerholc C; de Boever C; Meynard J; Michelet C; Michon C; Mole M; Netzer E; Pialoux G; Poizot Martin I; Raffi F; Ratajczak M; Ravaux I; Reynes J; Salmon Ceron D; Sebire M; Simon A; Tegna L; Tisne Dessus D; Tramoni C; Viard J; Vidal M; Viet Peaucelle C; Weiss L; Zeng A; Zucman D; Adam A; Arastéh K; Behrens G; Bergmann F; Bickel M; Bittner D; Bogner J; Brockmeyer N; Darrelmann N; Deja M; Doerler M; Esser S; Faetkenheuer G; Fenske S; Gajetzki S; Gey D; Goebel F; Gorriahn D; Harrer E; Harrer T; Hartl H; Hartmann M; Heesch S; Jakob W; Jäger H; Klinker H; Kremer G; Ludwig C; Mantzsch K; Mauss S; Meurer A; Niedermeier A; Pittack N; Plettenberg A; Potthoff A; Probst M; Rittweger M; Rockstroh J; Ross B; Rotty J; Rund E; Ruzicka T; Schmidt R; Schmutz G; Schnaitmann E; Schuster D; Sehr T; Spaeth B; Staszewski S; Stellbrink H; Stephan C; Stockey T; Stoehr A; Tillmann K; Trein A; Vaeth T; Vogel M; Wasmuth J; Wengenroth C; Winzer R; Wolf E; Mulcahy F; Reidy D; Cohen Y; Drora G; Eliezer I; Godo O; Kedem E; Magen E; Mamorsky M; Pollack S; Sthoeger Z; Vered H; Yust I; Aiuti F; Bechi M; Bergamasco A; Bertelli D; Bruno R; Butini L; Cagliuso M; Carosi G; Casari S; Chrysoula V; Cologni G; Conti V; Costantini A; Corpolongo A; D'Offizi G; Gaiottino F; Di Pietro M; Esposito R; Filice G; Francesco M; Gianelli E; Graziella C; Magenta L; Martellotta F; Maserati R; Mazzotta F; Murdaca G; Nardini G; Nozza S; Puppo F; Pogliaghi M; Ripamonti D; Ronchetti C; Rusconi S; Rusconi V; Sacchi P; Silvia N; Suter F; Tambussi G; Uglietti A; Vechi M; Vergani B; Vichi F; Vitiello P; Iwamoto A; Kikuchi Y; Miyazaki N; Mori M; Nakamura T; Odawara T; Oka S; Shirasaka T; Tabata M; Takano M; Ueta C; Watanabe D; Yamamoto Y; Erradey I; Himmich H; Marhoum El Filali K; Blok W; van Boxtel R; Brinkman H. Doevelaar K; van Eeden A; Grijsen M; Groot M; Juttmann J; Kuipers M; Ligthart S; van der Meulen P; Lange J; Langebeek N; Ligthart S; Reiss P; Richter C; Schoemaker M; Schrijnders Gudde L; Septer Bijleveld E; Sprenger H; Vermeulen J; Bruun J; Kvale D; Maeland A; Bakowska E; Beniowski M; Boron Kaczmarska A; Gasiorowski J; Horban A; Inglot M; Knysz B; Mularska E; Parczewski M; Pynka M; Rymer W; Szymczak A; Aldir M; Antunes F; Baptista C; da Conceicao Vera J; Doroana M; Mansinho K; dos Santos C; Valadas E; Vaz Pinto I; Chia E; Foo E; Karim F; Lim P; Panchalingam A; Paton N; Quek A; Alcázar Caballero R; Aragon E; Arnaiz J; Arribas J; Arrizabalaga J; de Barron X; Blanco F; Bouza E; Bravo I; Calvo S; Carbonero L; Carpena I; Castro M; Clotet B; Cortes L; del Toro M; Domingo P; Elias M; Espinosa J; Estrada V; Fernandez Cruz E; Fernández P; Freud H; Fuster M; Garcia A; Garcia G; Garrido R; Gatell J; Gijón P; Gonzalez García J; Gil I; González A; González Lahoz J; López Grosso P; Gutierrez M; Guzmán E; Iribarren J; Jiménez M; Jou A; Juega J; Lopez J; Lopez P; Lozano F; Martín Carbonero L; Mata R; Mateo G; Menasalvas A; Mirelles C; de Miguel Prieto J; Montes M; Moreno A; Moreno J; Moreno V; Muñoz R; Ocampo A; Ortega E; Ortiz L; Padilla B; Parras A; Paster A; Pedreira J; Peña J; Perea R; Portas B; Puig J; Pulido F; Rebollar M; de Rivera J; Roca V; Rodríguez Arrondo F; Rubio R; Santos J; Sanz J; Sebastian G; Segovia M; Soriano V; Tamargo L; Varea S; Viciana P; von Wichmann M; Bratt G; Hollander A; Olov Pehrson P; Petz I; Sandstrom E; Sönnerborg A; Bernasconi E; Gurtner V; Ampunpong U; Auchieng C; Bowonwatanuwong C; Chanchai P; Chetchotisakd P; Chuenyan T; Duncombe C; Horsakulthai M; Kantipong P; Laohajinda K; Phanuphak P; Pongsurachet V; Pradapmook S; Ruxruntham K; Seekaew S; Sonjai A; Suwanagool S; Techasathit W; Ubolyam S; Wankoon J; Alexander I; Dockrell D; Easterbrook P; Edwards B; Evans E; Fisher M; Fox R; Gazzard B; Gilleran G; Hand J; Heald L; Higgs C; Jebakumar S; Jendrulek I; Johnson M; Johnson S; Karim F; Kinghorn G; Kuldanek K; Leen C; Maw R; McKernan S; McLean L; Morris S; Murphy M; O'Farrell S; Ong E; Peters B; Stroud C; Wansbrough Jones M; Weber J; White D; Williams I; Wiselka M; Yee T; Adams S; Allegra D; Andrews L; Aneja B; Anstead G; Arduino R; Artz R; Bailowitz J; Banks S; Baxter J; Baum J; Benator D; Black D; Boh D; Bonam T; Brito M; Brockelman J; Brown S; Bruzzese V; Burnside A. Jr; Cafaro V; Casey K; Cason L; Childress G; Clark C; Clifford D; Climo M; Cohn D; Couey P; Cuervo H; Davey R. Jr; Deeks S; Dennis M; Diaz Linares M; Dickerson D; Diez M; Di Puppo J; Dodson P; Dupre D; Elion R; Elliott K; El Sadr W; Estes M; Fabre J; Farrough M; Flamm J; Follansbee S; Foster C; Frank C; Franz J; Frechette G; Freidland G; Frische J; Fuentes L; Funk C; Geisler C; Genther K; Giles M; Goetz M; Gonzalez M; Graeber C; Graziano F; Grice D; Hahn B; Hamilton C; Hassler S; Henson A; Hopper S; John M; Johnson L; Johnson M; Johnson R; Jones R; Kahn J; Kelly M; Klimas N; Kolber M; Koletar S; Labriola A; Larsen R; Lasseter F; Lederman M; Ling T; Lusch T; MacArthur R; Machado C; Makohon L; Mandelke J; Mannheimer S; Markowitz N; Martínez M; Martinez N; Mass M; Masur H; McGregor D; McIntyre D; McKee J; McMullen D; Mettinger M; Middleton S; Mieras J; Mildvan D; Miller P; Miller T; Mitchell V; Mitsuyasu R; Moanna A; Mogridge C; Moran F; Murphy R; Mushatt D; Nahass R; Nixon D; O'Brien S; Ojeda J; Okhuysen P; Olson M; Osterberger J; Owen W. Sr; Pablovich S; Patel S; Perez G; Pierone G. Jr; Poblete R; Potter A; Preston E; Rappoport C; Regevik N; Reyelt M; Rhame F; Riney L; Rodriguez Barradas M; Rodriguez M; Rodriguez M; Rodriguez J; Roland R; Rosmarin DeStefano C; Rossen W; Rouff J; Saag M; Sampson J; Santiago S; Sarria J; Wirtz S; Schmidt U; Scott C; Sheridan A; Shin A; Shrader S; Simon G; Slowinski D; Smith K; Spotkov J; Sprague C; States D; Suh C; Sullivan J; Summers K; Sweeton B; Tan V; Tanner T; Tedaldi E; Temesgen Z; Thomas D; Thompson M; Tobin C; Toro N; Towner W; Upton K; Uy J; Valenti S; van der Horst C; Vita J; Voell J; Walker J; Walton T; Wason K; Watson V; Wellons A; Weise J; White M; Whitman T; Williams B; Williams N; Windham J; Witt M; Workowski K; Wortmann G; Wright T; Zelasky C; Zwickl B; Gordin F; Finley E; Dietz D; Chesson C; Vjecha M; Standridge B; Schmetter B; Grue L; Willoughby M; Demers A; Lundgren J; Phillips A; Dragsted U; Jensen K; Fau A; Borup L; Pearson M; Jansson P; Jensen B; Benfield T; Darbyshire J; Babiker A; Palfreeman A; Fleck S; Collaco Moraes Y; Cordwell B; Dodds W; van Hooff F; Wyzydrag L; Cooper D; Emery S; Drummond F; Connor S; Satchell C; Gunn S; Oka S; Delfino M; Merlin K; McGinley C; Neaton J; Bartsch G; DuChene A; George M; Grund B; Harrison M; Hogan C; Krum E; Larson G; Miller C; Nelson R; Neuhaus J; Roediger M; Schultz T; Thackeray L; Prineas R; Campbell C; Perez G; Lifson A; Duprez D; Hoy J; Lahart C; Perlman D; Price R; Prineas R; Rhame F; Sampson J; Worley J; Rein M; DerSimonian R; Brody B; Daar E; Dubler N; Fleming T; Freeman D; Kahn J; Kim K; Medoff G; Modlin J; Moellering R. Jr; Murray B; Pick B; Robb M; Scharfstein D; Sugarman J; Tsiatis A; Tuazon C; Zoloth L; Klingman K; Lehrman S; Lazovski J; Belloso W; Losso M; Benetucci J; Aquilia S; Bittar V; Bogdanowicz E; Cahn P; Casiró A; Cassetti I; Contarelli J; Corral J; Crinejo A; Daciuk L; David D; Guaragna G; Ishida M; Krolewiecki A; Laplume H; Lasala M; Lourtau L; Lupo S; Maranzana A; Masciottra F; Michaan M; Ruggieri L; Salazar E; Sánchez M; Somenzini C; Hoy J; Rogers G; Allworth A; Anderson J; Armishaw J; Barnes K; Carr A; Chiam A; Chuah J; Curry M; Dever R; Donohue W; Doong N; Dwyer D; Dyer J; Eu B; Ferguson V; French MA; Garsia R; Gold J; Hudson JH; Jeganathan S; Konecny P; Leung J; McCormack C; McMurchie M; Medland N; Moore R; Moussa M; Orth D; Piper M; Read T; Roney J; Roth N; Shaw D; Silvers J; Smith D; Street AC; Vale R; Wendt N; Wood H; Youds D; Zillman J; Rieger A; Tozeau V; Aichelburg A; Vetter N; Clumeck N; Dewit S; de Roo A; Kabeya K; Leonard P; Lynen L; Moutschen M; O'Doherty E; Pereira L. Jr; Souza T; Schechter M; Zajdenverg R; Almeida M; Araujo F; Bahia F; Brites C; Caseiro M; Casseb J; Etzel A; Falco G; Filho E; Flint S; Gonzales C; Madruga J; Passos L; Reuter T; Sidi L; Toscano A; Zarowny D; Cherban E; Cohen J; Conway B; Dufour C; Ellis M; Foster A; Haase D; Haldane H; Houde M; Kato C; Klein M; Lessard B; Martel A; Martel C; McFarland N; Paradis E; Piche A; Sandre R; Schlech W; Schmidt S; Smaill F; Thompson B; Trottier S; Vezina S; Walmsley S; Wolff Reyes M; Northland R; Ostergaard L; Pedersen C; Nielsen H; Hergens L; Loftheim I; Jensen K; Raukas M; Zilmer K; Justinen J; Ristola M; Girard P; Landman R; Abel S; Abgrall S; Amat K; Auperin L; Barruet R; Benalycherif A; Benammar N; Bensalem M; Bentata M; Besnier J; Blanc M; Bouchaud O; Cabié A; Chavannet P; Chennebault J; Dargere S; de la Tribonniere X; Debord T; Decaux N; Delgado J; Dupon M; Durant J; Frixon Marin V; Genet C; Gérard L; Gilquin J; Hoen B; Jeantils V; Kouadio H; Leclercq P; Lelièvre JD; Levy Y; Michon C; Nau P; Pacanowski J; Piketty C; Poizot Martin I; Raymond I; Salmon D; Schmit J; Serini M; Simon A; Tassi S; Touam F; Verdon R; Weinbreck P; Weiss L; Yazdanpanah Y; Yeni P; Fätkenheuer G; Staszewski S; Bergmann F; Bitsch S; Bogner J; Brockmeyer N; Esser S; Goebel F; Hartmann M; Klinker H; Lehmann C; Lennemann T; Plettenberg A; Potthof A; Rockstroh J; Ross B; Stoehr A; Wasmuth J; Wiedemeyer K; Winzer R; Hatzakis A; Touloumi G; Antoniadou A; Daikos G; Dimitrakaki A; Gargalianos Kakolyris P; Giannaris M; Karafoulidou A; Katsambas A; Katsarou O; Kontos A; Kordossis T; Lazanas M; Panagopoulos P; Panos G; Paparizos V; Papastamopoulos V; Petrikkos G; Sambatakou H; Skoutelis A; Tsogas N; Xylomenos G; Bergin C; Mooka B; Pollack S; Mamorksy M; Agmon Levin N; Karplus R; Kedem E; Maayan S; Shahar E; Sthoeger Z; Turner D; Yust I; Tambussi G; Rusconi V; Abeli C; Bechi M; Biglino A; Bonora S; Butini L; Carosi G; Casari S; Corpolongo A; De Gioanni M; Di Perri G; Di Pietro M; D'Offizi G; Esposito R; Mazzotta F; Montroni M; Nardini G; Nozza S; Quirino T; Raise E; Honda M; Ishisaka M; Caplinskas S; Uzdaviniene V; Schmit J; Staub T; Himmich H; Marhoum El Filali K; Mills G; Blackmore T; Masters JA; Morgan J; Pithie A; Brunn J; Ormasssen V; La Rosa A; Guerra O; Espichan M; Gutierrez L; Mendo F; Salazar R; Knytz B; Horban A; Bakowska E; Beniowski M; Gasiorowski J; Kwiatkowski J; Antunes F; Castro R; Doroana M; Horta A; Mansinho K; Miranda A; Pinto I; Valadas E; Vera J; Rakhmanova A; Vinogradova E; Yakovlev A; Zakharova N; Wood R; Orrel C; Gatell J; Arnaiz J; Carrillo R; Clotet B; Dalmau D; González A; Jordano Q; Jou A; Knobel H; Larrousse M; Mata R; Moreno J; Oretaga E; Pena J; Pulido F; Rubio R; Sanz J; Viciana P; Hirschel B; Spycher R; Battegay M; Bernasconi E; Bottone S; Cavassini M; Christen A; Franc C; Furrer H; Gayet Ageron A; Genné D; Hochstrasser S; Magenta L; Moens C; Müller N; Nüesch R; Phanuphak P; Ruxrungtham K; Pumpradit W; Chetchotisakd P; Dangthongdee S; Kiertiburanakul S; Klinbuayaem V; Mootsikapun P; Nonenoy S; Piyavong B; Prasithsirikul W; Raksakulkarn P; Gazzard B; Ainsworth J; Anderson J; Angus B; Barber T; Brook M; Care C; Chadwick D; Chikohora M; Churchill D; Cornforth D; Dockrell D; Easterbrook P; Fox P; Fox R; Gomez P; Gompels M; Harris G; Herman S; Jackson A; Jebakumar S; Johnson M; Kinghorn G; Kuldanek K; Larbalestier N; Leen C; Lumsden M; Maher T; Mantell J; Maw R; McKernan S; McLean L; Morris S; Muromba L; Orkin C; Palfreeman A; Peters B; Peto T; Portsmouth S; Rajamanoharan S; Ronan A; Schwenk A; Slinn M; Stroud C; Thomas R; Wansbrough Jones M; Whiles H; White D; Williams E; Williams I; Youle M; Abrams D; Acosta E; Adams S; Adamski A; Andrews L; Antoniskis D; Aragon D; Arduino R; Artz R; Bailowitz J; Barnett B; Baroni C; Barron M; Baxter J; Beers D; Beilke M; Bemenderfer D; Bernard A; Besch C; Bessesen M; Bethel J; Blue S; Blum J; Boarden S; Bolan R; Borgman J; Brar I; Braxton B; Bredeek U; Brennan R; Britt D; Brockelman J; Brown S; Bruzzese V; Bulgin Coleman D; Bullock D; Cafaro V; Campbell B; Caras S; Carroll J; Casey K; Chiang F; Childress G; Cindrich R; Clark C; Climo M; Cohen C; Coley J; Condoluci D; Contreras R; Corser J; Cozzolino J; Crane L; Daley L; Dandridge D; D'Antuono V; Darcourt Rizo J; DeHovitz J; DeJesus E; DesJardin J; Diaz Linares M; Dietrich C; Dodson P; Dolce E; Elliott K; Erickson D; Estes M; Faber L; Falbo J; Farrough M; Farthing C; Ferrell Gonzalez P; Flynn H; Frank C; Frank M; Freeman K; French N; Friedland G; Fujita N; Gahagan L; Genther K; Gilson I; Goetz M; Goodwin E; Graziano F; Guity C; Gulick P; Gunderson E; Hale C; Hannah K; Henderson H; Hennessey K; Henry W; Higgins D; Hodder S; Horowitz H; Howe Pittman M; Hubbard J; Hudson R; Hunter H; Hutelmyer C; Insignares M; Jackson L; Jenny L; John M; Johnson D; Johnson G; Johnson J; Johnson L; Kaatz J; Kaczmarski J; Kagan S; Kantor C; Kempner T; Kieckhaus K; Kimmel N; Klaus B; Klimas N; Koeppe J; Koirala J; Kopka J; Kostman J; Kozal M; Kumar A; Labriola A; Lampiris H; Lamprecht C; Lattanzi K; Lee J; Leggett J; Long C; Loquere A; Loveless K; Lucasti C; Luskin Hawk R; MacVeigh M; Makohon L; Mannheimer S; Markowitz N; Marks C; Martinez N; Martorell C; McFeaters E; McGee B; McIntyre D; McKee J; McManus E; Melecio L; Melton D; Mercado S; Merrifield E; Mieras J; Mogyoros M; Moran F; Murphy K; Mushatt D; Mutic S; Nadeem I; Nadler J; Nahass R; Nixon D; O'Brien S; Ognjan A; O'Hearn M; O'Keefe K; Okhuysen P; Oldfield E; Olson D; Orenstein R; Ortiz R; Osterberger J; Owen W; Parpart F; Pastore Lange V; Paul S; Pavlatos A; Pearce D; Pelz R; Perez G; Peterson S; Pierone G. Jr; Pitrak D; Powers S; Pujet H; Raaum J; Ravishankar J; Reeder J; Regevik N; Reilly N; Reyelt C; Riddell J; Rimland D; Robinson M; Rodriguez A; Rodriguez Barradas M; Rodriguez Derouen V; Roland R; Rosmarin C; Rossen W; Rouff J; Sampson J; Sands M; Savini C; Schrader S; Schulte M; Scott C; Scott R; Seedhom H; Sension M; Sheble Hall A; Sheridan A; Shuter J; Slater L; Slotten R; Slowinski D; Smith M; Snap S; States D; Stewart M; Stringer G; Sullivan J; Summers K; Swanson K; Sweeton I; Szabo S; Tedaldi E; Telzak E; Temesgen Z; Thomas D; Thompson M; Thompson S; Ting Hong Bong C; Tobin C; Uy J; Vaccaro A; Vasco L; Vecino I; Verlinghieri G; Visnegarwala F; Wade B; Watson V; Weis S; Weise J; Weissman S; Wilkin A; Williams L; Witter J; Wojtusic L; Wright T; Yeh V; Young B; Zeana C; Zeh J; Savio E; Vacarezza M.
2015-01-01
Abstract
BACKGROUND:
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.
METHODS AND FINDINGS:
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.
CONCLUSIONS:
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.
Non ci sono file associati a questo prodotto.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
Sei sicuro che questo prodotto debba essere cancellato?
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande. La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.