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Risk Factors for Acute Renal Failure (ARF) in Ambulatory Patient Infected with HIV

Purpose: To identify an ambulatory HIV-infected patient who is at risk for acute renal failure based on the study of Franceschini et al.

Description

Franceschini et al identified risk factors for acute renal failure (ARF) in ambulatory patients infected with HIV. These can help identify patients who may benefit from more aggressive management. The authors are from the University of North Carolina and Duke University.


Baseline Serum Creatinine

Persistent Increase Defining ARF

< 2.0 mg/dL

>= 0.5 mg/dL

2.0 to 5.0 mg/dL

>= 1.0 mg/dL

> 5.0 mg/dL

>= 1.5 mg/dL

 

Parameters:

(1) CD4 lymphocyte count

(2) HCV infection

 

CD4 Count

HCV Coinfected

ARF Episodes per 100 Person Years

>= 200 per µL

no

0

>= 200 per µL

yes

1.9

< 200 per µL

no

3.7

< 200 per µL

yes

4.3

 

where:

• The increase in serum creatinine should last for >= 2 days for ARF.

• The ARF episodes are estimates from a multivariate log-linear regression model controlled for other variables.

• The rate for < 200 CD4 per µL is pretty much the same irregardless of HCV status.

 

Other factors associated with ARF:

(1) increasing plasma HIV RNA levels (correlates with CD4 count)

(2) first year of HAART therapy

(3) dehydration during acute illness

(4) polypharmacy including potentially nephrotoxic drugs

 


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Specialty

Objective

ICD-10