Chronic kidney disease at presentation is not an independent risk factor for AIDS-defining events or death in HIV-infected persons.

Studies have documented an association between chronic kidney disease (CKD) and increased risk of end stage renal disease, death and comorbidities, including cardiovascular disease and metabolic syndrome, in the general population. However, there is little data on the relationship between CKD and ADE (AIDS defining event), and to our knowledge, no studies have analyzed death as a competing risk for ADE among HIV-infected persons. An observational cohort study was performed to determine the incidence and risks for developing an ADE or death among HIV-infected persons with and without CKD from 1998 - 2005. CKD was defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 using the CKDEpidemiology Collaboration (CKD-EPI) equation. Log rank test and Cox regression which determined time to development of ADE and/or death as combined and separate outcomes, and competing risk models for ADE versus mortality, were performed. Among the 2,127 persons that contributed to the 5,824 person years of follow-up: 22% were female, 34% African American, 38% on HAART, and 3% had CKD at baseline. ADE occurred in 227 (11%) persons and there were 80 (4%) deaths. CKD was not significantly associated with ADE/death (HR 1.3, 95% CIs: 0.5, 3.2), ADE (HR 1.0, 95% CIs: 0.4, 3.1), or death (HR 1.6, 95% CIs: 0.4, 3.1). Competing risk analyses confirmed no statistically significant associations between CKD and these outcomes. CKD was uncommon in HIV-infected persons presenting for care in this racially diverse cohort, and was not independently associated with risk of developing an ADE or dying during follow-up.

Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database.

BACKGROUND: Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial. STUDY DESIGN: Retrospective analysis of the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database derived from 2 prospective randomized controlled clinical trials (IDNT [Irbesartan Diabetic Nephropathy Trial] and RENAAL [Reduction of Endpoints in Non-Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan]). SETTING & PARTICIPANTS: 3,228 adult patients with type 2 diabetic nephropathy from IDNT and RENAAL were combined to establish the DIAMETRIC database. This is the largest global source of clinical information for patients with type 2 diabetic nephropathy who have decreased kidney function and significant proteinuria. INTERVENTION: Angiotensin receptor blocker versus non-angiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials). OUTCOMES & MEASUREMENTS: Incidence rates of ESRD, cardiovascular death, and all-cause mortality. RESULTS: Mean follow-up was 2.8 years; 19.5% of patients developed ESRD, approximately 2.5 times the incidence of cardiovascular death and 1.5 times the incidence of all-cause mortality. ESRD was more common than cardiovascular death in all subgroups analyzed with the exception of participants with low levels of albuminuria (albumin excretion <1.0 g/g) and well-preserved levels of kidney function (estimated glomerular filtration rate >45 mL/min/1.73 m(2)) at baseline. LIMITATIONS: All participants were included in a prospective clinical trial. CONCLUSIONS: Patients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements.

Diabetic nephropathy among Mexican Americans.

The incidence of diabetic nephropathy (DN) is growing rapidly worldwide as a consequence of the rising prevalence of Type 2 diabetes mellitus (T2DM). Among U.S. ethnic groups, Mexican Americans have a disproportionately high incidence and prevalence of DN and associated end-stage renal disease (ESRD). In communities bordering Mexico, as many as 90% of Mexican American patients with ESRD also suffer from T2DM compared to only 50% of non-Hispanic Whites (NHW). Both socio-economic factors and genetic predisposition appear to have a strong influence on this association. In addition, certain pathogenetic and clinical features of T2DM and DN are different in Mexican Americans compared to NHW, raising questions as to whether the diagnostic and treatment strategies that are standard practice in the NHW patient population may not be applicable in Mexican Americans. This article reviews the epidemiology of DN in Mexican Americans, describes the pathophysiology and associated risk factors, and identifies gaps in our knowledge and understanding that needs to be addressed by future investigations.

Rate of ESRD exceeds mortality among African Americans with hypertensive nephrosclerosis.

In several studies, patients with CKD seemed to be at greater risk for dying from cardiovascular disease (CVD) than reaching ESRD. The purpose of this study was to compare incident ESRD rates with rates of total mortality, CVD death, and a CVD composite (CVD mortality and CVD hospitalization) among participants who had hypertensive nephrosclerosis and were enrolled in the African American Study of Kidney Disease and Hypertension (AASK). The study period included the AASK trial phase (1996 through 2001) and a subsequent cohort phase (2002 through 2007). The AASK enrolled 1094 participants. Of the 764 participants who completed the trial phase without an event, 691 (90%) enrolled in the cohort phase. During 11 years of follow-up, there were 59 CVD-related deaths and 118 non-CVD-related deaths. The rate of ESRD (3.9/100 patient-years) was significantly higher than the rates of total mortality (2.2/100 patient-years), CVD mortality (0.8/100 patient-years), and the CVD composite (3.2/100 patient-years). The incidence rate ratio of ESRD to CVD mortality was 5.0. The rate of ESRD consistently exceeded the various mortality rates across most of the subgroups defined by age, gender, income, education, previous CVD, baseline urine protein excretion, and baseline estimated GFR. In conclusion, AASK participants were more likely to reach ESRD than to die.

Race, kidney disease progression, and mortality risk in HIV-infected persons.

BACKGROUND AND OBJECTIVES: The burden of HIV-associated chronic kidney disease (CKD) is growing in the United States, partially because of increased HIV-infection rates among African Americans. We determined the prevalence, incidence, and risk of rapid estimated GFR (eGFR) decline, ESRD, and death among HIV-infected (HIV+) African-American and non-African-American individuals cared for at the Comprehensive Care Center in Nashville, Tennessee, from January 1, 1998, through December 31, 2005. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Mixed effects, competing risks, and Poisson and Cox regression models were used to assess the risk of rapid eGFR decline (defined as ≥50% decrease in baseline eGFR), CKD5/ESRD, and death. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate eGFR. Confounders were adjusted with a propensity score that related patient characteristics to the probability of being African American. Mixed effects models compared the rate of rapid eGFR decline for HIV-infected African Americans and non-African Americans. RESULTS: There were 2468 HIV-infected individuals in the study: 33% African American; 21% female. Among all patients, HIV-infected African Americans did not have a statistically significant increased risk for rapid eGFR decline compared with non-African Americans. However, African Americans had a significantly higher risk of ESRD and tended toward a higher risk of death. CONCLUSIONS: HIV-infected African Americans did not have a statistically significant difference in the risk of eGFR decline when compared with HIV-infected non-African Americans. The findings in this study have potential public health significance.