2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Acute Kidney Injury (AKI)

Slide4of63FromJE Locke,MD,MPHatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.

Risk Factors and Common Etiologies

Risk factors for AKI • Male gender, CD4<200, VL>10,000, HCV co-infection, ART use (not traditional)

Most common etiologies • 38% Prerenal (due to infection, predominantly OIs) • 46% Intrinsic (ischemic ATN or nephrotoxic medications)

Francheschini et al. KI 2002

Slide5of63FromJE Locke,MD,MPHatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.

AKI in HIV - Incidence

Ambulatory patients ( Francheschini et al. KI 2002) • Prospective cohort study of 754 HIV+ patients followed for 2 years • Mean age 40, 61% black, 68% on ART, 3% have GFR<60ml/m at enrollment • ARF defined as increase in Scr • Etiologies categorized: prerenal, intrinsic, obstructive • 111 episodes AKI in 71 subjects; incidence rate 5.9 per person years Hospitalized patients ( Wyatt et al. AIDS 2006) • AKI is a strong predictor of in hospital mortality in the general population • Examine hospital discharge billing data/codes for NYS in 2003 • 25,114 patients admitted with HIV compared with 2,010,847 non-HIV admissions • Risk factors for AKI?

Slide6of63FromJE Locke,MD,MPHatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.