HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

BMC Nephrology

Tejinder S Ahuja⁴  Lawrence Y Agodoa¹  Fernando C Trespalacios²  Kevin C Abbott³ 

[1] NIDDK, NIH, Bethesda, MD, USA;Nephrology Service, Madigan Army Medical Center, Tacoma, Washington, D.C, USA;Nephrology Service, Walter Reed Army Medical Center, Washington, DC, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA;Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, TX, USA

关键词: hyperparathyroidism;    heart failure;    USRDS;    dihydropyridine;    calcium channel blockers;    end-stage renal disease;    dialysis;    angiotensin converting enzyme inhibitors;    antiretroviral;    HIV;   

Others  :  1083452
DOI  :  10.1186/1471-2369-4-5

 received in 2003-03-25, accepted in 2003-07-01,  发布年份 2003

【 摘 要 】

Background

The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN), namely of angiotensin converting enzyme inhibitors (ACE) and antiretroviral therapy, has not been reported for a national sample of dialysis patients.

Methods

We conducted a historical cohort study of the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR) with HIVAN as a cause of end stage renal disease (ESRD) and its impact on mortality during the study period, adjusted for potential confounders.

Results

Of the 3374 patients who started dialysis, 36 (1.1%) had ESRD as a result of HIVAN. Only 22 (61%) of patients with HIVAN received antiretroviral agents, and only nine patients (25%) received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60), or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p < 0.01) compared to patients with other causes of ESRD.

Conclusions

Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.

【 授权许可】

   
2003 Abbott et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

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