A study recently published in BMJ Open has revealed a significant increase in hospital admissions for kidney diseases (KD) in people living with HIV (PLHIV) in France. The observational nationwide study conducted over a six-year period (2008-2013) aimed to describe hospitalizations due to KD and identify the risk factors associated with such admissions.
The research, led by Magali M. Louis and her team from the Infectious Diseases Department at the University Hospital in Dijon, France, is deemed vital as global data on the epidemiology of KD leading to hospitalization among HIV patients remains scarce. The study employed data from the French Programme de Médicalisation des Systèmes d’Information database, examining a cohort of 10,862 PLHIV out of approximately 5.2 million patients hospitalized each year.
Key Findings of the Study
According to Louis and colleagues, PLHIV were 1.5 times more likely to be hospitalized for KD than the general population. The prevalence of PLHIV hospitalized for KD saw a sharp rise from 3.0% in 2008 to 3.7% in 2013, signifying an increasing trend over time.
The foremost cause of KD hospitalizations was acute renal failure (ARF), constituting 25.4% of cases. While glomerular diseases remained stable at 6.4%, focal segmental glomerulosclerosis was the leading diagnosis within this category, with a rate of 37.6%. Notably, only 41.3% of patients hospitalized for glomerular diseases underwent a renal biopsy, indicating possible underdiagnosis or misclassification. Other prevalent reasons for hospitalization included nephrolithiasis (22.1%) and pyelonephritis (22.6%).
The cumulative 5-year incidence rate of KD requiring hospitalization for newly diagnosed HIV patients in 2009 was 5.9%. Risk factors identified for higher incidents of KD hospitalization included cardiovascular disease, with a HR of 3.30, and AIDS in female patients, with a HR of 2.45. Alarmingly, two-thirds of hospitalizations for ARF occurred within the first 2 years of follow-up.
Implication of the Findings
This study highlights an urgent need for healthcare systems to address the challenges posed by KD in PLHIV. With admission rates for KD increasing over time and ARF being the leading cause of hospitalization, there are evident clinical and public health concerns. The infrequent documentation of glomerular diseases by renal biopsies also requires attention, as this indicates possible gaps in diagnostic practices.
Given that older patients and those with cardiovascular disease are particularly susceptible, these findings call for enhanced screening and preventive measures for KD among PLHIV. As HIV management continues to advance, co-morbid conditions such as KD present new complexities in the care continuum for PLHIV.
Critical Analysis
The study is comprehensive in scope and innovative, considering the limited global research focused on KD hospitalizations in the HIV-positive population. However, potential limitations include its retrospective nature and potential biases in the use of administrative hospital databases. Despite these constraints, the research by Louis et al. successfully exploits a large dataset and provides a solid foundation for policy-making and clinical guidelines in managing KD among PLHIV.
Conclusions
The marked uptick in hospital admissions for kidney diseases among people living with HIV in France is a public health issue that demands immediate attention. The study underscores the critical need for awareness and targeted healthcare interventions to manage what appears to be an escalating burden of KD in the HIV-infected population.
Furthermore, the research sets the stage for future studies and acts as a benchmark for other nations grappling with similar healthcare challenges among their PLHIV cohorts.
The paper by Magali M. Louis et al., titled “Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study,” is available with the DOI: 10.1136/bmjopen-2019-029211.
References
1. Louis, M. M., et al. (2019). Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study. BMJ Open, 9(5), e029211. DOI: 10.1136/bmjopen-2019-029211
2. Wyatt, C.M., et al. (2006). Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS, 20(5), 561-565.
3. Lucas, G.M., et al. (2014). Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis, 59(10), e96-e138.
4. Choi, A.I., et al. (2010). Long-term clinical consequences of acute kidney injury in the HIV-infected. Kidney Int, 78(3), 478-485.
5. Naicker, S., et al. (2008). Epidemiology of acute kidney injury in Africa. Semin Nephrol, 28(4), 348-353.
Keywords
1. HIV-associated kidney diseases
2. Acute renal failure in PLHIV
3. Kidney disease hospitalization HIV
4. HIV and glomerular diseases
5. Kidney health and HIV management