Evolution of kidney function after five years of follow-up in a large Spanish cohort of patients with HIV: Risk factors for progression

Background Antiretroviral therapy has improved life expectancy in HIV patients; however the increase in longevity has led to comorbidities, with chronic kidney disease (CKD) being especially concerning. CKD may evolve into end-stage kidney disease and, in the worst case, result in patient death. In this context, it is important to identify the patients at risk of CKD progression and to characterize the associated risk factors. Methods A retrospective observational study (2014–2019) was conducted in HIV-infected patients enrolled in a Spanish cohort. We analyzed the CKD prevalence and its progression after five years of follow-up, considering predictive factors. Results The prevalence of CKD increased from 2.83% in 2014 to 7.94% in 2019. Among patients without CKD at baseline, 43.4% progressed to occult kidney disease (OKD), and 19% developed CKD after five years. Multivariate analysis identified age as the strongest independent factor for CKD, with rates increasing from 14.3% in 2014 to 32.1% in 2019, among individuals older than 64 years. The addition of the proteinuria as a biomarker only helped us to identify 7% of patients who evolved to OKD and 30% of patients who progressed to CKD. Conclusions This study confirms the increased risk of developing CKD in a Spanish HIV cohort after five years of follow up, with age as the strongest risk factor. Furthermore, proteinuria proved to be a limited biomarker for predicting CKD progression, highlighting the need to identify new biomarkers capable of detecting the risk of CKD progression in this population.