NEW YORK—People living with both HIV and diabetes are much more likely to develop progressive chronic kidney disease (CKD) than people living with only one of the conditions, according to a study conducted by Veterans Healthcare Administration investigators and published ahead of print by the Journal of Acquired Immune Deficiency Syndromes.
"These results suggest that patients with both HIV and diabetes may benefit from more frequent screening of CKD, more rigorous follow-up of existing CKD, and more aggressive management of CKD risk factors," Christina Wyatt, MD, of Mount Sinai School of Medicine in New York City and her fellow authors conclude. "This hypothesis should be evaluated in future research studies."
About 15 percent of people living with HIV have diabetes. While several studies have suggested that HIV and diabetes have an additive effect on CKD progression, few research teams have looked closely at confounding factors that can potentially skew data, notably the prevalence of traditional risk factors for kidney disease among HIV-positive people (for example, high viral loads and low CD4 cell counts).
To explore this further, Wyatt and her colleagues followed more than 30,000 veterans for an average of five years, using estimated glomerular filtration rate (eGFR) calculations to monitor kidney function. All study subjects had normal eGFRs—greater than 45 milliliters per minute per 1.73 square meters of body-surface area (ml/min/1.732). The average eGFR, for all cohort participants at the start of the follow-up period, was 95 ml/min/1.732.