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=> "Díaz-Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 10 => array:3 [ "nombre" => "Jesús" "apellidos" => "Grande-Villoria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Nefrología, Hospital Virgen de la Concha, Zamora, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna, Hospital Virgen de la Concha, Zamora, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de enfermedad renal crónica en pacientes infectados por el virus de la inmunodeficiencia humana" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12248_16025_54636_en_t112248.jpg" "Alto" => 1892 "Ancho" => 2168 "Tamanyo" => 817293 ] ] "descripcion" => array:1 [ "en" => "Prevalence of chronic kidney disease in different cohorts and related risk factors." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor</span></p><p class="elsevierStylePara">Antiretroviral therapy has dramatically improved the prognosis and survival of patients infected with the human immunodeficiency virus (HIV).<span class="elsevierStyleSup">1 </span>This new situation has allowed pathologies to develop that in previous decades were considered to be less significant. Within this context, there is a growing interest in chronic kidney disease (CKD), and there are discrepancies both in terms of its prevalence and the factors involved in its development, including antiretroviral drugs (Table 1).<span class="elsevierStyleSup">2-11</span></p><p class="elsevierStylePara">With these objectives in mind (prevalence and risk factors), we reviewed patients treated at the Infectious Diseases Clinic of Zamora over a 6 month-period (October 2012-April 2013). Inclusion criteria: HIV infection, with at least two consecutive visits. Patients with concomitant acute disease at the time of the visit and/or those with a follow-up period of less than three months were excluded. We reviewed their medical histories and recorded their age, sex, weight, body mass index, follow-up time, concomitant chronic diseases (diabetes mellitus [DM], high blood pressure [HBP], chronic hepatitis B and/or C virus), smoking status, creatinine, phosphorus, proteinuria (measured by the albumin/creatinine ratio [A/CR]), urinary sediment, current CD4 count, CD4 nadir, the presence of AIDS, HIV RNA, antiretroviral therapy and tenofovir therapy (current and/or previous).</p><p class="elsevierStylePara">Estimated glomerular filtration rate (eGFR) was calculated using the MDRD (Modification of Diet in Renal Disease) and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations, with six categories being assigned in accordance with the recommendations of the National Kidney Foundation. CKD was defined as a decrease in kidney function, expressed by a glomerular filtration rate of <60ml/min/1.73m<span class="elsevierStyleSup">2</span> and/or persistent proteinuria (A/CR >30mg/g) for at least 3 months.</p><p class="elsevierStylePara">For statistical analysis, we used the SPSS 11.5.1 software. The association study was carried out using Χ<span class="elsevierStyleSup">2</span>, exact tests, the Student’s t-test or ANOVA and multivariate logistic regression.</p><p class="elsevierStylePara">In accordance with the above mentioned criteria, we excluded 5 patients and included 195, whose epidemiological and clinical characteristics are displayed in Table 2. eGFR, calculated by MDRD, was 99.8±26.6ml/min/1.73m<span class="elsevierStyleSup">2</span>, and by CKD-EPI, it was 98.4±18.4ml/min/1.73m<span class="elsevierStyleSup">2</span>. The distribution by category was as follows: G1 124 patients (63.6%), G2 67 (34.4%), G3a 3 (1.5%), G3b 0, G4 0, G5 1 (0.5%) with MDRD, and G1 140 (71.8%), G2 52 (26.6%), G3a 2 (1.0%), G3b 0, G4 0, G5 1 (0.5%), with CKD-EPI. A total of 15 patients (7.7%) had proteinuria and 4 of them had an eGFR <60ml/min/1.73m<span class="elsevierStyleSup">2</span>. On applying the MDRD formula, we found CKD in 18 (9.2%), and using CKD-EPI, in 17 (8.7%) (Table 2). Furthermore, 14 patients had microhaematuria, 5 had glycosuria (2 without DM) and 16 had hypophosphataemia. If we took into account any of these abnormalities, that is, eGFR <60 and/or proteinuria and/or microhaematuria and/or glycosuria and/or hypophosphataemia, 45 patients (23.1%) would be diagnosed with renal dysfunction. One or several cardiovascular risk factors (CVRF) were found in 87.2% and in 100% of those with CKD. Hyperlipidaemia and smoking were the most prevalent CVRF, followed by HBP and DM (Table 2). Differences in CKD prevalence were not found in patients with or without antiretroviral therapy, or between those treated and not treated with tenofovir (current and/or previous).</p><p class="elsevierStylePara">Variables associated with CKD were age, HBP and a low CD4 nadir (CD4 <200 cells/mm³) (Table 2). In the multivariate analysis, CKD was significantly associated with hbp (odds ratio [OR]: 3.1, p=.028) and a low CD4 nadir (OR=3.3, p=.03).</p><p class="elsevierStylePara">CKD prevalence was 9.2%, which is similar to that observed in the general Spanish population (9.16%).<span class="elsevierStyleSup">11</span> In patients infected with HIV, the data were conflicting, probably due to the lack of homogeneity in the criteria used for defining CKD. In Barcelona and in the EUROSIDA cohort, the results were similar to those expressed herein<span class="elsevierStyleSup">4,5</span> (Table 1).</p><p class="elsevierStylePara">In line with other publications, the data presented suggest that the development of CKD is associated with HBP and with a low CD4 nadir<span class="elsevierStyleSup">2,3,5,6,8-10</span> (Table 1). It was not observed that antiretroviral therapy or specifically tenofovir had a significant influence in this regard. We believe that this finding is particularly relevant, given its high use in this series.</p><p class="elsevierStylePara">We consider that these observations once again reveal similarities between those infected by HIV and the rest of the population: similar CKD, with HBP as the main risk factor. Its control, as with the rest of patients, seems to be essential in preventing CKD development. Furthermore, as has been demonstrated in many studies, poor immunity (low CD4 nadir) implies a worse prognosis and facilitates the development of many complications, among which we should probably include CKD.</p><p class="elsevierStylePara">The results presented suggest that CKD development in patients infected with HIV depends on two modifiable factors: low CD4 nadir and HBP. The control of both  should be a main target in the daily work, and our task decisive.<span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span><br></br> <br></br>The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12248_16025_54636_en_t112248.jpg" class="elsevierStyleCrossRefs"><img src="12248_16025_54636_en_t112248.jpg" alt="Prevalence of chronic kidney disease in different cohorts and related risk factors."></img></a></p><p class="elsevierStylePara">Table 1. Prevalence of chronic kidney disease in different cohorts and related risk factors.</p><p class="elsevierStylePara"><a href="grande/12248_16025_54637_en_t212248.jpg" class="elsevierStyleCrossRefs"><img src="12248_16025_54637_en_t212248.jpg" alt="Demographic and clinical characteristics and comorbidities (the estimated glomerular filtration rate was calculated by MDRD)."></img></a></p><p class="elsevierStylePara">Table 2. Demographic and clinical characteristics and comorbidities (the estimated glomerular filtration rate was calculated by MDRD).</p>" "pdfFichero" => "P1-E565-S4507-A12248-EN.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439266" "palabras" => array:1 [ 0 => "Tenofovir" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439268" "palabras" => array:1 [ 0 => "Epidemiology" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439270" "palabras" => array:1 [ 0 => "Chronic kidney disease" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439272" "palabras" => array:1 [ 0 => "Human immunodeficiency virus" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12248_16025_54636_en_t112248.jpg" "Alto" => 1892 "Ancho" => 2168 "Tamanyo" => 817293 ] ] "descripcion" => array:1 [ "en" => "Prevalence of chronic kidney disease in different cohorts and related risk factors." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12248_16025_54637_en_t212248.jpg" "Alto" => 1933 "Ancho" => 2168 "Tamanyo" => 1254540 ] ] "descripcion" => array:1 [ "en" => "Demographic and clinical characteristics and comorbidities (the estimated glomerular filtration rate was calculated by MDRD)." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Antiretroviral Therapy Cohort Collaboration. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 10 | 10 | 20 |
2024 October | 39 | 38 | 77 |
2024 September | 50 | 48 | 98 |
2024 August | 73 | 65 | 138 |
2024 July | 46 | 37 | 83 |
2024 June | 82 | 39 | 121 |
2024 May | 82 | 27 | 109 |
2024 April | 85 | 41 | 126 |
2024 March | 76 | 29 | 105 |
2024 February | 33 | 39 | 72 |
2024 January | 31 | 24 | 55 |
2023 December | 29 | 24 | 53 |
2023 November | 51 | 26 | 77 |
2023 October | 43 | 26 | 69 |
2023 September | 38 | 28 | 66 |
2023 August | 43 | 21 | 64 |
2023 July | 74 | 34 | 108 |
2023 June | 45 | 20 | 65 |
2023 May | 83 | 31 | 114 |
2023 April | 66 | 14 | 80 |
2023 March | 91 | 19 | 110 |
2023 February | 50 | 19 | 69 |
2023 January | 44 | 18 | 62 |
2022 December | 53 | 27 | 80 |
2022 November | 54 | 27 | 81 |
2022 October | 54 | 41 | 95 |
2022 September | 35 | 25 | 60 |
2022 August | 40 | 52 | 92 |
2022 July | 49 | 42 | 91 |
2022 June | 55 | 39 | 94 |
2022 May | 50 | 31 | 81 |
2022 April | 36 | 51 | 87 |
2022 March | 41 | 43 | 84 |
2022 February | 65 | 47 | 112 |
2022 January | 89 | 34 | 123 |
2021 December | 46 | 44 | 90 |
2021 November | 40 | 23 | 63 |
2021 October | 50 | 49 | 99 |
2021 September | 66 | 36 | 102 |
2021 August | 46 | 35 | 81 |
2021 July | 76 | 31 | 107 |
2021 June | 63 | 30 | 93 |
2021 May | 76 | 47 | 123 |
2021 April | 132 | 63 | 195 |
2021 March | 80 | 42 | 122 |
2021 February | 71 | 19 | 90 |
2021 January | 69 | 24 | 93 |
2020 December | 55 | 13 | 68 |
2020 November | 49 | 23 | 72 |
2020 October | 33 | 21 | 54 |
2020 September | 34 | 12 | 46 |
2020 August | 52 | 11 | 63 |
2020 July | 51 | 11 | 62 |
2020 June | 47 | 17 | 64 |
2020 May | 43 | 10 | 53 |
2020 April | 56 | 19 | 75 |
2020 March | 57 | 22 | 79 |
2020 February | 46 | 19 | 65 |
2020 January | 49 | 27 | 76 |
2019 December | 72 | 25 | 97 |
2019 November | 48 | 22 | 70 |
2019 October | 33 | 13 | 46 |
2019 September | 60 | 16 | 76 |
2019 August | 56 | 24 | 80 |
2019 July | 67 | 22 | 89 |
2019 June | 65 | 20 | 85 |
2019 May | 51 | 17 | 68 |
2019 April | 100 | 46 | 146 |
2019 March | 91 | 39 | 130 |
2019 February | 31 | 22 | 53 |
2019 January | 43 | 21 | 64 |
2018 December | 98 | 44 | 142 |
2018 November | 78 | 12 | 90 |
2018 October | 96 | 19 | 115 |
2018 September | 84 | 6 | 90 |
2018 August | 46 | 16 | 62 |
2018 July | 42 | 11 | 53 |
2018 June | 57 | 14 | 71 |
2018 May | 66 | 17 | 83 |
2018 April | 66 | 12 | 78 |
2018 March | 67 | 16 | 83 |
2018 February | 71 | 19 | 90 |
2018 January | 34 | 9 | 43 |
2017 December | 58 | 13 | 71 |
2017 November | 53 | 14 | 67 |
2017 October | 45 | 6 | 51 |
2017 September | 46 | 24 | 70 |
2017 August | 51 | 14 | 65 |
2017 July | 43 | 10 | 53 |
2017 June | 47 | 23 | 70 |
2017 May | 57 | 11 | 68 |
2017 April | 47 | 12 | 59 |
2017 March | 40 | 32 | 72 |
2017 February | 61 | 15 | 76 |
2017 January | 36 | 8 | 44 |
2016 December | 60 | 10 | 70 |
2016 November | 85 | 9 | 94 |
2016 October | 177 | 15 | 192 |
2016 September | 180 | 1 | 181 |
2016 August | 230 | 11 | 241 |
2016 July | 234 | 10 | 244 |
2016 June | 141 | 0 | 141 |
2016 May | 147 | 0 | 147 |
2016 April | 135 | 0 | 135 |
2016 March | 105 | 0 | 105 |
2016 February | 125 | 0 | 125 |
2016 January | 114 | 0 | 114 |
2015 December | 121 | 0 | 121 |
2015 November | 113 | 0 | 113 |
2015 October | 115 | 0 | 115 |
2015 September | 92 | 0 | 92 |
2015 August | 95 | 0 | 95 |
2015 July | 94 | 0 | 94 |
2015 June | 57 | 0 | 57 |
2015 May | 56 | 0 | 56 |
2015 April | 20 | 0 | 20 |