Abstract / Summary
The association of modifiable risk factors with incident chronic kidney disease (CKD) among persons with HIV (PWH) and without HIV (PWoH), including alcohol use disorder, diabetes, dyslipidemia, hypertension, smoking, and potentially tenofovir (alafenamide compared with disoproxil fumarate) is not well established. We evaluated the association between these factors and incident CKD among PWH compared with PWoH, and tenofovir among PWH. We identified adult PWH and PWoH (frequency matched 1:20) in Kaiser Permanente from 2000 to 2023 and followed until incident CKD (eGFR < 60 ml/min/1.73m 2 based on ≥ 2 measures ≥ 90 days apart), disenrollment, death, or 12/31/2023. Primary predictors were the risk factors listed above. Analyses were adjusted for demographic and clinical covariates extracted from electronic health records. The overall cohort was 87% male, 35% non-Hispanic White, 24% Black, and 24% Hispanic. Among PWH and PWoH, there were 5,516 and 41,899 incident CKD events, respectively, with rates of 1.99 and 0.75 per 100 person-years (adjusted rate ratio of 2.52; p < 0.001). Hypertension, diabetes and dyslipidemia were significantly associated with higher risk of CKD among PWH, while alcohol use were associated with lower risk. Traditional risk factors for CKD were not as strongly associated among PWH as PWoH (all p < 0.001). Among PWH, tenofovir use was associated with lower adjusted risk of CKD; protection was significantly higher with tenofovir alafenamide compared with tenofovir disoproxil fumarate. Modifiable risk factors impact associated risk of CKD among PWH, especially in comparison with PWoH. Improved renal health requires hypertension, lipid, and diabetes control, and using tenofovir alafenamide.