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3&#46;1&#44; p&#61;&#46;028&#41; and a low CD4 nadir &#40;OR&#61;3&#46;3&#44; p&#61;&#46;03&#41;&#46;</p><p class="elsevierStylePara">CKD prevalence was 9&#46;2&#37;&#44; which is similar to that observed in the general Spanish population &#40;9&#46;16&#37;&#41;&#46;<span class="elsevierStyleSup">11</span> In patients infected with HIV&#44; the data were conflicting&#44; probably due to the lack of homogeneity in the criteria used for defining CKD&#46; In Barcelona and in the EUROSIDA cohort&#44; the results were similar to those expressed herein<span class="elsevierStyleSup">4&#44;5</span> &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">In line with other publications&#44; the data presented suggest that the development of CKD is associated with HBP and with a low CD4 nadir<span class="elsevierStyleSup">2&#44;3&#44;5&#44;6&#44;8-10</span> &#40;Table 1&#41;&#46; It was not observed that antiretroviral therapy or specifically tenofovir had a significant influence in this regard&#46; We believe that this finding is particularly relevant&#44; given its high use in this series&#46;</p><p class="elsevierStylePara">We consider that these observations once again reveal similarities between those infected by HIV and the rest of the population&#58; similar CKD&#44; with HBP as the main risk factor&#46; Its control&#44; as with the rest of patients&#44; seems to be essential in preventing CKD development&#46; Furthermore&#44; as has been demonstrated in many studies&#44; poor immunity &#40;low CD4 nadir&#41; implies a worse prognosis and facilitates the development of many complications&#44; among which we should probably include CKD&#46;</p><p class="elsevierStylePara">The results presented suggest that CKD development in patients infected with HIV depends on two modifiable factors&#58; low CD4 nadir and HBP&#46; The control of both&#160; should be a main target in the daily work&#44; and our task decisive&#46;<span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span><br></br>&#160;<br></br>The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12248&#95;16025&#95;54636&#95;en&#95;t112248&#46;jpg" class="elsevierStyleCrossRefs"><img src="12248_16025_54636_en_t112248.jpg" alt="Prevalence of chronic kidney disease in different cohorts and related risk factors&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Prevalence of chronic kidney disease in different cohorts and related risk factors&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12248&#95;16025&#95;54637&#95;en&#95;t212248&#46;jpg" class="elsevierStyleCrossRefs"><img src="12248_16025_54637_en_t212248.jpg" alt="Demographic and clinical characteristics and comorbidities &#40;the estimated glomerular filtration rate was calculated by MDRD&#41;&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Demographic and clinical characteristics and comorbidities &#40;the estimated glomerular filtration rate was calculated by MDRD&#41;&#46;</p>"
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Prevalence of chronic kidney disease in patients infected by the human immunodeficiency virus
Prevalencia de enfermedad renal crónica en pacientes infectados por el virus de la inmunodeficiencia humana
Anunciación González-Lópeza, Ángel Chocarro-Martínezb, Felipe Alvárez-Naviab, Sara Álvarez-Tundidora, Beatriz Andrés-Martína, Álvaro Nava-Rebolloa, Henar Santana-Zapateroa, Julia Diego-Martína, Cipriano Escaja-Mugaa, Hugo Díaz-Molinaa, Jesús Grande-Villoriaa
a Sección de Nefrología, Hospital Virgen de la Concha, Zamora,
b Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna, Hospital Virgen de la Concha, Zamora,
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    "textoCompleto" => "<p class="elsevierStylePara">&#160;</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 &#40;HIV&#41;&#46;<span class="elsevierStyleSup">1 </span>This new situation has allowed pathologies to develop that in previous decades were considered to be less significant&#46; Within this context&#44; there is a growing interest in chronic kidney disease &#40;CKD&#41;&#44; and there are discrepancies both in terms of its prevalence and the factors involved in its development&#44; including antiretroviral drugs &#40;Table 1&#41;&#46;<span class="elsevierStyleSup">2-11</span></p><p class="elsevierStylePara">With these objectives in mind &#40;prevalence and risk factors&#41;&#44; we reviewed patients treated at the Infectious Diseases Clinic of Zamora over a 6 month-period &#40;October 2012-April 2013&#41;&#46; Inclusion criteria&#58; HIV infection&#44; with at least two consecutive visits&#46; Patients with concomitant acute disease at the time of the visit and&#47;or those with a follow-up period of less than three months were excluded&#46; We reviewed their medical histories and recorded their age&#44; sex&#44; weight&#44; body mass index&#44; follow-up time&#44; concomitant chronic diseases &#40;diabetes mellitus &#91;DM&#93;&#44; high blood pressure &#91;HBP&#93;&#44; chronic hepatitis B and&#47;or C virus&#41;&#44; smoking status&#44; creatinine&#44; phosphorus&#44; proteinuria &#40;measured by the albumin&#47;creatinine ratio &#91;A&#47;CR&#93;&#41;&#44; urinary sediment&#44; current CD4 count&#44; CD4 nadir&#44; the presence of AIDS&#44; HIV RNA&#44; antiretroviral therapy and tenofovir therapy &#40;current and&#47;or previous&#41;&#46;</p><p class="elsevierStylePara">Estimated glomerular filtration rate &#40;eGFR&#41; was calculated using the MDRD &#40;Modification of Diet in Renal Disease&#41; and CKD-EPI &#40;Chronic Kidney Disease Epidemiology Collaboration&#41; equations&#44; with six categories being assigned in accordance with the recommendations of the National Kidney Foundation&#46; CKD was defined as a decrease in kidney function&#44; expressed by a glomerular filtration rate of &#60;60ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> and&#47;or persistent proteinuria &#40;A&#47;CR &#62;30mg&#47;g&#41; for at least 3 months&#46;</p><p class="elsevierStylePara">For statistical analysis&#44; we used the SPSS 11&#46;5&#46;1 software&#46; The association study was carried out using &#935;<span class="elsevierStyleSup">2</span>&#44; exact tests&#44; the Student&#8217;s t-test or ANOVA and multivariate logistic regression&#46;</p><p class="elsevierStylePara">In accordance with the above mentioned criteria&#44; we excluded 5 patients and included 195&#44; whose epidemiological and clinical characteristics are displayed in Table 2&#46; eGFR&#44; calculated by MDRD&#44; was 99&#46;8&#177;26&#46;6ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; and by CKD-EPI&#44; it was 98&#46;4&#177;18&#46;4ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; The distribution by category was as follows&#58; G1 124 patients &#40;63&#46;6&#37;&#41;&#44; G2 67 &#40;34&#46;4&#37;&#41;&#44; G3a 3 &#40;1&#46;5&#37;&#41;&#44; G3b 0&#44; G4 0&#44; G5 1 &#40;0&#46;5&#37;&#41; with MDRD&#44; and G1 140 &#40;71&#46;8&#37;&#41;&#44; G2 52 &#40;26&#46;6&#37;&#41;&#44; G3a 2 &#40;1&#46;0&#37;&#41;&#44; G3b 0&#44; G4 0&#44; G5 1 &#40;0&#46;5&#37;&#41;&#44; with CKD-EPI&#46; A total of 15 patients &#40;7&#46;7&#37;&#41; had proteinuria and 4 of them had an eGFR &#60;60ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; On applying the MDRD formula&#44; we found CKD in 18 &#40;9&#46;2&#37;&#41;&#44; and using CKD-EPI&#44; in 17 &#40;8&#46;7&#37;&#41; &#40;Table 2&#41;&#46; Furthermore&#44; 14 patients had microhaematuria&#44; 5 had glycosuria &#40;2 without DM&#41; and 16 had hypophosphataemia&#46; If we took into account any of these abnormalities&#44; that is&#44; eGFR&#160;&#60;60 and&#47;or proteinuria and&#47;or microhaematuria and&#47;or glycosuria and&#47;or hypophosphataemia&#44; 45 patients &#40;23&#46;1&#37;&#41; would be diagnosed with renal dysfunction&#46; One or several cardiovascular risk factors &#40;CVRF&#41; were found in 87&#46;2&#37; and in 100&#37; of those with CKD&#46; Hyperlipidaemia and smoking were the most prevalent CVRF&#44; followed by HBP and DM &#40;Table 2&#41;&#46; Differences in CKD prevalence were not found in patients with or without antiretroviral therapy&#44; or between those treated and not treated with tenofovir &#40;current and&#47;or previous&#41;&#46;</p><p class="elsevierStylePara">Variables associated with CKD were age&#44; HBP and a low CD4 nadir &#40;CD4 &#60;200 cells&#47;mm&#179;&#41; &#40;Table 2&#41;&#46; In the multivariate analysis&#44; CKD was significantly associated with hbp &#40;odds ratio &#91;OR&#93;&#58; 3&#46;1&#44; p&#61;&#46;028&#41; and a low CD4 nadir &#40;OR&#61;3&#46;3&#44; p&#61;&#46;03&#41;&#46;</p><p class="elsevierStylePara">CKD prevalence was 9&#46;2&#37;&#44; which is similar to that observed in the general Spanish population &#40;9&#46;16&#37;&#41;&#46;<span class="elsevierStyleSup">11</span> In patients infected with HIV&#44; the data were conflicting&#44; probably due to the lack of homogeneity in the criteria used for defining CKD&#46; In Barcelona and in the EUROSIDA cohort&#44; the results were similar to those expressed herein<span class="elsevierStyleSup">4&#44;5</span> &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">In line with other publications&#44; the data presented suggest that the development of CKD is associated with HBP and with a low CD4 nadir<span class="elsevierStyleSup">2&#44;3&#44;5&#44;6&#44;8-10</span> &#40;Table 1&#41;&#46; It was not observed that antiretroviral therapy or specifically tenofovir had a significant influence in this regard&#46; We believe that this finding is particularly relevant&#44; given its high use in this series&#46;</p><p class="elsevierStylePara">We consider that these observations once again reveal similarities between those infected by HIV and the rest of the population&#58; similar CKD&#44; with HBP as the main risk factor&#46; Its control&#44; as with the rest of patients&#44; seems to be essential in preventing CKD development&#46; Furthermore&#44; as has been demonstrated in many studies&#44; poor immunity &#40;low CD4 nadir&#41; implies a worse prognosis and facilitates the development of many complications&#44; among which we should probably include CKD&#46;</p><p class="elsevierStylePara">The results presented suggest that CKD development in patients infected with HIV depends on two modifiable factors&#58; low CD4 nadir and HBP&#46; The control of both&#160; should be a main target in the daily work&#44; and our task decisive&#46;<span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span><br></br>&#160;<br></br>The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12248&#95;16025&#95;54636&#95;en&#95;t112248&#46;jpg" class="elsevierStyleCrossRefs"><img src="12248_16025_54636_en_t112248.jpg" alt="Prevalence of chronic kidney disease in different cohorts and related risk factors&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Prevalence of chronic kidney disease in different cohorts and related risk factors&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12248&#95;16025&#95;54637&#95;en&#95;t212248&#46;jpg" class="elsevierStyleCrossRefs"><img src="12248_16025_54637_en_t212248.jpg" alt="Demographic and clinical characteristics and comorbidities &#40;the estimated glomerular filtration rate was calculated by MDRD&#41;&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Demographic and clinical characteristics and comorbidities &#40;the estimated glomerular filtration rate was calculated by MDRD&#41;&#46;</p>"
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ISSN: 20132514
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